MEDICARE: MS. BONNIE FRANCES MCCREDIE 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
1	1041C0700X	Clinical Social Worker	SW3179	FL

General Provider Information

NPI Number	:	1609186048
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BONNIE FRANCES MCCREDIE LCSW

Provider Business Mailing Address
First Line	:	2207 S CAROLINA AVE
Second Line	:	#28
City	:	TAMPA
State	:	FL
Zip	:	33629-6290
Country	:	US
Telephone Number	:	813-943-7041
Fax Number	:

Provider Business Practice Location Address
First Line	:	1308 W SLIGH AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33604-5902
Country	:	US
Telephone Number	:	813-375-3980
Fax Number	:

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

Provider Enumeration Date	:	10/19/2010
Last Update Date	:	10/19/2010

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