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NPI Code Detail

MEDICARE: JAMES VERTREES LCSW

MEDICARE: JAMES VERTREES 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
11041C0700XClinical Social WorkerSW21296FL

General Provider Information

NPI Number : 1730884099
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMES VERTREES LCSW
Provider Business Mailing Address
First Line : 1940 HARRISON AVE
Second Line :
City : PANAMA CITY
State : FL
Zip : 32405-4542
Country : US
Telephone Number : 850-763-0017
Fax Number : 850-692-5862
Provider Business Practice Location Address
First Line : 7108 QUAIL HOLLOW DR
Second Line :
City : PANAMA CITY BEACH
State : FL
Zip : 32408-4984
Country : US
Telephone Number : 850-279-5614
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/04/2023
Last Update Date : 04/04/2023

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