MEDICARE: MR. EAYANN E TAFFE 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 5322	FL

General Provider Information

NPI Number	:	1801029525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. EAYANN E TAFFE LCSW

Provider Business Mailing Address
First Line	:	7340 SADDLE RD
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33463-7627
Country	:	US
Telephone Number	:	561-319-6587
Fax Number	:

Provider Business Practice Location Address
First Line	:	2311 10TH AVE N
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33461-6605
Country	:	US
Telephone Number	:	561-585-0441
Fax Number	:

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

Provider Enumeration Date	:	08/27/2009
Last Update Date	:	08/27/2009

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