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NPI Code Detail

MEDICARE: JILL BYRUM LCSW

MEDICARE: JILL BYRUM LCSW
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
11041C0700XClinical Social WorkerSW 2324FL

General Provider Information

NPI Number : 1396899589
Entity Type Code : Individual
Provider Name (Legal Business Name) : JILL BYRUM LCSW
Provider Business Mailing Address
First Line : 4500 W MIDWAY RD
Second Line :
City : FORT PIERCE
State : FL
Zip : 34981-4823
Country : US
Telephone Number : 772-468-5600
Fax Number : 772-467-3054
Provider Business Practice Location Address
First Line : 4500 W MIDWAY RD
Second Line :
City : FORT PIERCE
State : FL
Zip : 34981-4823
Country : US
Telephone Number : 772-468-5600
Fax Number : 772-467-3054
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/23/2007
Last Update Date : 07/09/2007

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