MEDICARE: P&W ASSOCIATES PSYCHOLOGICAL SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	0-072360	FL
2	1041C0700X	Clinical Social Worker	10873	FL

General Provider Information

NPI Number	:	1396093688
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	P&W ASSOCIATES PSYCHOLOGICAL SERVICES

Provider Business Mailing Address
First Line	:	1155 BRICKELL BAY DR APT 1806
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33131-3215
Country	:	US
Telephone Number	:	786-514-9847
Fax Number	:

Provider Business Practice Location Address
First Line	:	1155 BRICKELL BAY DR APT 1806
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33131-3215
Country	:	US
Telephone Number	:	786-514-9847
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	AMADO JESUS PINERO
Credential	:	LCSW
Telephone Number	:	786-514-9847

Provider Enumeration Date	:	08/17/2012
Last Update Date	:	08/17/2012

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