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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