MEDICARE: MR. MATTHEW SORENSON

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	1041C0700X	Clinical Social Worker	SW15155	FL

General Provider Information

NPI Number	:	1396270286
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MATTHEW SORENSON

Provider Business Mailing Address
First Line	:	3000 OASIS GRAND BLVD
Second Line	:	#1004
City	:	FORT MYERS
State	:	FL
Zip	:	33916-1524
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3000 OASIS GRAND BLVD
Second Line	:	#1004
City	:	FORT MYERS
State	:	FL
Zip	:	33916-1524
Country	:	US
Telephone Number	:	239-848-0004
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/27/2017
Last Update Date	:	04/03/2018

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Directions to “ MR. MATTHEW SORENSON ” Practice Location

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