Provider Demographics
NPI:1417007881
Name:NATIONAL BOARD OF FORENSIC EVALUATORS
Entity Type:Organization
Organization Name:NATIONAL BOARD OF FORENSIC EVALUATORS
Other - Org Name:COUNSELING AND PSYCHOTHERAPY CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:VICE PRESIDENT ADMINISTRATIVE DIR
Authorized Official - Prefix:DR
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:G
Authorized Official - Last Name:WATT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:386-677-3995
Mailing Address - Street 1:595 W GRANADA BLVD STE H
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-5182
Mailing Address - Country:US
Mailing Address - Phone:386-677-3995
Mailing Address - Fax:386-673-0130
Practice Address - Street 1:595 W GRANADA BLVD STE H
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-5182
Practice Address - Country:US
Practice Address - Phone:386-677-3995
Practice Address - Fax:386-673-0130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW00031421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ5161Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER