MEDICARE: DENESHA MCCRAY

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	SW16146	FL

General Provider Information

NPI Number	:	1972137305
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENESHA MCCRAY

Provider Business Mailing Address
First Line	:	1000 JEFFERSON ST STE 2C
Second Line	:
City	:	LYNCHBURG
State	:	VA
Zip	:	24504-1724
Country	:	US
Telephone Number	:	904-507-6712
Fax Number	:	617-807-0958

Provider Business Practice Location Address
First Line	:	4243 SUNBEAM RD STE 1
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-8975
Country	:	US
Telephone Number	:	904-507-6712
Fax Number	:	617-807-0958

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

Provider Enumeration Date	:	02/25/2020
Last Update Date	:	02/25/2020

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