MEDICARE: MS. WENDY RENE PUGH L.I.S.W.

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	104100000X	Social Worker	SW18813	FL
2	104100000X	Social Worker	S0600265	OH
3	1041C0700X	Clinical Social Worker	I110127	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528237278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. WENDY RENE PUGH L.I.S.W.

Provider Business Mailing Address
First Line	:	341 N MAITLAND AVE STE 340
Second Line	:
City	:	MAITLAND
State	:	FL
Zip	:	32751-4761
Country	:	US
Telephone Number	:	407-219-3281
Fax Number	:

Provider Business Practice Location Address
First Line	:	341 N MAITLAND AVE STE 340
Second Line	:
City	:	MAITLAND
State	:	FL
Zip	:	32751-4761
Country	:	US
Telephone Number	:	407-219-3281
Fax Number	:

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

Provider Enumeration Date	:	02/27/2008
Last Update Date	:	01/19/2022

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