MEDICARE: NATIONAL BOARD OF FORENSIC EVALUATORS

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	SW0003142	FL

General Provider Information

NPI Number	:	1417007881
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NATIONAL BOARD OF FORENSIC EVALUATORS

Provider Business Mailing Address
First Line	:	595 W GRANADA BLVD STE H
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-5182
Country	:	US
Telephone Number	:	386-677-3995
Fax Number	:	386-673-0130

Provider Business Practice Location Address
First Line	:	595 W GRANADA BLVD STE H
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-5182
Country	:	US
Telephone Number	:	386-677-3995
Fax Number	:	386-673-0130

Authorized Official
Title or Position	:	VICE PRESIDENT ADMINISTRATIVE DIR
Name	:	DR. VALERIE G WATT
Credential	:	PH.D.
Telephone Number	:	386-677-3995

Provider Enumeration Date	:	01/10/2007
Last Update Date	:	08/22/2020

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