MEDICARE: MRS. MARY MALDONADO-BERMUDEZ 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	1781	FL

General Provider Information

NPI Number	:	1689661159
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY MALDONADO-BERMUDEZ L.C.S.W.

Provider Business Mailing Address
First Line	:	7590 NW 186TH ST
Second Line	:	SUITE 208
City	:	MIAMI
State	:	FL
Zip	:	33015-2952
Country	:	US
Telephone Number	:	305-362-8326
Fax Number	:	305-362-1244

Provider Business Practice Location Address
First Line	:	7590 NW 186TH ST
Second Line	:	SUITE 208
City	:	MIAMI
State	:	FL
Zip	:	33015-2952
Country	:	US
Telephone Number	:	305-362-8326
Fax Number	:	305-362-1244

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

Provider Enumeration Date	:	09/30/2005
Last Update Date	:	07/08/2007

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