MEDICARE: OLIVIA CREARY L.C.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	1041C0700X	Clinical Social Worker	SW 6450	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	SW 6450	OTHER	FL	STATE OF FLORIDA DEPARTME

General Provider Information

NPI Number	:	1669670683
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLIVIA CREARY L.C.S.W.

Provider Business Mailing Address
First Line	:	BROWARD COMMUNITY AND FAMILY HEALTH CENTERS INC
Second Line	:	168 NORTH POWERLINE ROAD
City	:	POMPANO BEACH
State	:	FL
Zip	:	33021-3205
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	BROWARD COMMUNITY AND FAMILY HEALTH CENTERS, INC.
Second Line	:	168 NORTH POWERLINE ROAD
City	:	POMPANO BEACH
State	:	FL
Zip	:	33021-3205
Country	:	US
Telephone Number	:	954-967-0028
Fax Number	:	954-272-0294

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

Provider Enumeration Date	:	07/11/2007
Last Update Date	:	07/11/2007

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