Provider Demographics
NPI:1013416999
Name:MOBILEPREACHER.ORG
Entity Type:Organization
Organization Name:MOBILEPREACHER.ORG
Other - Org Name:DMR COUNSELING SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:RUBANO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:941-315-5999
Mailing Address - Street 1:2757 WILKINSON RD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34231-5232
Mailing Address - Country:US
Mailing Address - Phone:941-315-5999
Mailing Address - Fax:
Practice Address - Street 1:2881 CLARK RD STE 11
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-6298
Practice Address - Country:US
Practice Address - Phone:941-315-5999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-06
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW131341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019173200Medicaid