MEDICARE: LURIE COUNSELING SERVICES LLC

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	SW9381	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PENDING	OTHER	FL	MEDICARE PENDING

General Provider Information

NPI Number	:	1962738922
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LURIE COUNSELING SERVICES LLC

Provider Business Mailing Address
First Line	:	2105 LAVERS CIR
Second Line	:	#507
City	:	DELRAY BEACH
State	:	FL
Zip	:	33444-7606
Country	:	US
Telephone Number	:	561-573-3105
Fax Number	:

Provider Business Practice Location Address
First Line	:	2105 LAVERS CIR
Second Line	:	#507
City	:	DELRAY BEACH
State	:	FL
Zip	:	33444-7606
Country	:	US
Telephone Number	:	561-573-3105
Fax Number	:

Authorized Official
Title or Position	:	MGR
Name	:	JILL REBECCA LURIE
Credential	:	LCSW
Telephone Number	:	561-573-3105

Provider Enumeration Date	:	10/27/2009
Last Update Date	:	10/27/2009

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