MEDICARE: DENISE LEDERMAN LCSW, LNC, PA

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	251S00000X	Community/Behavioral Health Agency	SW4939	FL

General Provider Information

NPI Number	:	1598092827
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENISE LEDERMAN LCSW, LNC, PA

Provider Business Mailing Address
First Line	:	36000 PORTOFINO CIR
Second Line	:	SUITE 114
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33418-1284
Country	:	US
Telephone Number	:	954-234-9018
Fax Number	:

Provider Business Practice Location Address
First Line	:	36000 PORTOFINO CIR
Second Line	:	SUITE 114
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33418-1284
Country	:	US
Telephone Number	:	954-234-9018
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. DENISE RENEE LEDERMAN
Credential	:	LCSW
Telephone Number	:	954-234-9018

Provider Enumeration Date	:	11/06/2009
Last Update Date	:	11/06/2009

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