MEDICARE: MARTHA A BOZEMAN 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	SW 6205	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Z083G	OTHER	FL	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699727651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTHA A BOZEMAN LCSW

Provider Business Mailing Address
First Line	:	206 PARK PLACE BLVD
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34741-2344
Country	:	US
Telephone Number	:	407-846-0023
Fax Number	:	407-483-1064

Provider Business Practice Location Address
First Line	:	206 PARK PLACE BLVD
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34741-2344
Country	:	US
Telephone Number	:	407-846-0023
Fax Number	:	407-483-1064

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

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	07/08/2007

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