MEDICARE: DR. PAULA FLEISHER NELSON ED.D, LCSW, CAP, CET

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	4465	FL
2	1041C0700X	Clinical Social Worker	SW9101	FL

General Provider Information

NPI Number	:	1942611876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAULA FLEISHER NELSON ED.D, LCSW, CAP, CET

Provider Business Mailing Address
First Line	:	1340 LAKE POLO DR
Second Line	:
City	:	ODESSA
State	:	FL
Zip	:	33556-1700
Country	:	US
Telephone Number	:	813-951-8889
Fax Number	:

Provider Business Practice Location Address
First Line	:	1340 LAKE POLO DR
Second Line	:
City	:	ODESSA
State	:	FL
Zip	:	33556-1700
Country	:	US
Telephone Number	:	813-951-8889
Fax Number	:

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

Provider Enumeration Date	:	05/13/2014
Last Update Date	:	05/13/2014

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