MEDICARE: KIMBERLY EHLY M.S.W.

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	ISW 8174	FL

General Provider Information

NPI Number	:	1962832626
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY EHLY M.S.W.

Provider Business Mailing Address
First Line	:	2611 NW 51ST PL
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-2923
Country	:	US
Telephone Number	:	954-646-1000
Fax Number	:

Provider Business Practice Location Address
First Line	:	2611 NW 51ST PL
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-2923
Country	:	US
Telephone Number	:	954-646-1000
Fax Number	:

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

Provider Enumeration Date	:	11/17/2013
Last Update Date	:	11/17/2013

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