Organization
BACK DOOR, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHERYL L BUSS LCSW (MANAGING MEMBER)
(239) 745-5917
Entity
Organization
Contact information
Practice address
1639 CAPE CORAL PKWY E STE 211, CAPE CORAL, FL 33904-9657
(239) 745-5917
(866) 676-2762
Mailing address
1639 CAPE CORAL PKWY E STE 211, CAPE CORAL, FL 33904-9657
(239) 745-5917
(866) 676-2762
Taxonomy
Speciality
Code
Description
License number
State
103TP0016X
Prescribing (Medical) Psychologist
ME100060
FL
1041C0700X
Clinical Social Worker
Primary
SW8039
FL
Other
Enumeration date
08/18/2009
Last updated
11/17/2009
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