MEDICARE: MATTHEW BORER PH.D. LMFT

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	106H00000X	Marriage & Family Therapist	MT 2536	FL

General Provider Information

NPI Number	:	1982980603
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW BORER PH.D. LMFT

Provider Business Mailing Address
First Line	:	2720 PARK ST
Second Line	:	209
City	:	JACKSONVILLE
State	:	FL
Zip	:	32205-7644
Country	:	US
Telephone Number	:	904-874-1387
Fax Number	:

Provider Business Practice Location Address
First Line	:	2720 PARK ST
Second Line	:	209
City	:	JACKSONVILLE
State	:	FL
Zip	:	32205-7644
Country	:	US
Telephone Number	:	904-874-1387
Fax Number	:

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

Provider Enumeration Date	:	10/26/2011
Last Update Date	:	10/26/2011

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