MEDICARE: LISA FLORES, LCSW, P.A.

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	C000288	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	137103000	OTHER		MAGELLAN
2	4671115	OTHER		AETNA
3	087365	OTHER		VALUE OPTIONS
4	7565K	OTHER	NC	BCBS

General Provider Information

NPI Number	:	1720383607
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LISA FLORES, LCSW, P.A.

Provider Business Mailing Address
First Line	:	3518 DRAWBRIDGE PKWY
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27410-8432
Country	:	US
Telephone Number	:	336-545-3331
Fax Number	:	336-545-5142

Provider Business Practice Location Address
First Line	:	3518 DRAWBRIDGE PKWY
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27410-8432
Country	:	US
Telephone Number	:	336-545-3331
Fax Number	:	336-545-5142

Authorized Official
Title or Position	:	OWNER / PROVIDER
Name	:	LISA L SHELOR - FLORES
Credential	:
Telephone Number	:	336-545-3331

Provider Enumeration Date	:	01/24/2011
Last Update Date	:	01/24/2011

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Directions to “LISA FLORES, LCSW, P.A. ” Practice Location

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