MEDICARE: DIGITAL CARE TEAM OF FL, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	103TC0700X	Clinical Psychologist
2	101Y00000X	Counselor
3	101YM0800X	Mental Health Counselor
4	103T00000X	Psychologist
5	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1578274759
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIGITAL CARE TEAM OF FL, LLC

Provider Business Mailing Address
First Line	:	343 N WOOD DALE RD STE 201A
Second Line	:
City	:	WOOD DALE
State	:	IL
Zip	:	60191-1578
Country	:	US
Telephone Number	:	773-817-5928
Fax Number	:

Provider Business Practice Location Address
First Line	:	6251 PARK BLVD N UNIT 9C
Second Line	:
City	:	PINELLAS PARK
State	:	FL
Zip	:	33781-3238
Country	:	US
Telephone Number	:	773-817-5928
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	WAJAHATUDDIN MACCI
Credential	:
Telephone Number	:	773-817-5928

Provider Enumeration Date	:	12/08/2022
Last Update Date	:	01/12/2023

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