MEDICARE: PIPER NOELLE STANNARD VANDERLEE 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	SW13383	FL

General Provider Information

NPI Number	:	1760033500
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PIPER NOELLE STANNARD VANDERLEE LCSW

Provider Business Mailing Address
First Line	:	860 PINEWOOD TER W
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34683-2928
Country	:	US
Telephone Number	:	917-981-4413
Fax Number	:

Provider Business Practice Location Address
First Line	:	860 PINEWOOD TER W
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34683-2928
Country	:	US
Telephone Number	:	917-981-4413
Fax Number	:

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

Provider Enumeration Date	:	09/23/2019
Last Update Date	:	09/23/2019

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