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Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
LCSW

Contact information

Practice address
21 COLUMBIA ST STE 201, ORLANDO, FL 32806-1133
(407) 262-2220
(407) 834-5011
Mailing address
21 COLUMBIA ST STE 201, ORLANDO, FL 32806-1133
(407) 262-2220
(407) 834-5011

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
SW16008
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
102260400
FL
Enumeration date
05/19/2016
Last updated
03/30/2026
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