MEDICARE: MS. MAYRA SCHLOBACH BAGNOLI MSW

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	104100000X	Social Worker

General Provider Information

NPI Number	:	1689945636
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MAYRA SCHLOBACH BAGNOLI MSW

Provider Business Mailing Address
First Line	:	2820 RIO CLARO DR N
Second Line	:
City	:	WELLINGTON
State	:	FL
Zip	:	33414-3455
Country	:	US
Telephone Number	:	561-635-2431
Fax Number	:	866-834-9736

Provider Business Practice Location Address
First Line	:	2820 RIO CLARO DR N
Second Line	:
City	:	WELLINGTON
State	:	FL
Zip	:	33414-3455
Country	:	US
Telephone Number	:	561-635-2431
Fax Number	:

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

Provider Enumeration Date	:	01/23/2012
Last Update Date	:	06/24/2020

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