Provider Demographics
NPI:1093774036
Name:DEPT OF VETERANS AFFAIRS MEDICAL CENTER
Entity Type:Organization
Organization Name:DEPT OF VETERANS AFFAIRS MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:ROSALYN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:MSSW
Authorized Official - Phone:561-422-5525
Mailing Address - Street 1:210 MONTEREY WAY
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-7812
Mailing Address - Country:US
Mailing Address - Phone:561-204-2312
Mailing Address - Fax:
Practice Address - Street 1:7305 N MILITARY TRL
Practice Address - Street 2:
Practice Address - City:RIVIERA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33410-7417
Practice Address - Country:US
Practice Address - Phone:561-422-5525
Practice Address - Fax:561-422-7220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-20
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801081007104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty