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Organization
FLORIDA AGING MENTAL HEALTH LLC
Active
Organization
FLORIDA AGING MENTAL HEALTH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTOPHER ANTHONY WILCOX LCSW (LCSW CONSULTANT)
(352) 208-0284
Entity
Organization
Contact information
Practice address
5827 OAK BRIDGE CT, BRADENTON, FL 34211-1734
(352) 208-0284
Mailing address
10210 MARSH HARBOR WAY APT 6, RIVERVIEW, FL 33578
(352) 208-0284
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
14000
FL
1041C0700X
Clinical Social Worker
Primary
—
—
122300000X
Dentist
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
207N00000X
Dermatology Physician
—
—
2084N0400X
Neurology Physician
—
—
Other
Enumeration date
08/07/2017
Last updated
04/14/2023
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