MEDICARE: MR. SHEDRICK JOHN BOREN 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	SW5359	FL

General Provider Information

NPI Number	:	1720189913
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SHEDRICK JOHN BOREN LCSW

Provider Business Mailing Address
First Line	:	2143 FISHER ISLAND DR
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33109-0059
Country	:	US
Telephone Number	:	305-860-5246
Fax Number	:	305-285-5042

Provider Business Practice Location Address
First Line	:	2143 FISHER ISLAND DR
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33109-0059
Country	:	US
Telephone Number	:	305-860-5246
Fax Number	:	305-285-5042

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

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	07/08/2007

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Directions to “ MR. SHEDRICK JOHN BOREN LCSW” Practice Location

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