MEDICARE: APPHIA GLENN RCSWI

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

General Provider Information

NPI Number	:	1871216788
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	APPHIA GLENN RCSWI

Provider Business Mailing Address
First Line	:	2350 MINTON RD STE 103
Second Line	:
City	:	WEST MELBOURNE
State	:	FL
Zip	:	32904-6603
Country	:	US
Telephone Number	:	321-426-0359
Fax Number	:

Provider Business Practice Location Address
First Line	:	2350 MINTON RD
Second Line	:
City	:	WEST MELBOURNE
State	:	FL
Zip	:	32904-6603
Country	:	US
Telephone Number	:	321-426-0359
Fax Number	:

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

Provider Enumeration Date	:	09/26/2022
Last Update Date	:	09/26/2022

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