Provider Demographics
NPI:1336148691
Name:PELL, SHARON F (LCSW)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:F
Last Name:PELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1555 PORT MALABAR BLVD NE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905-5407
Mailing Address - Country:US
Mailing Address - Phone:321-724-0394
Mailing Address - Fax:327-952-2516
Practice Address - Street 1:1555 PORT MALABAR BLVD NE
Practice Address - Street 2:SUITE 104
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-5407
Practice Address - Country:US
Practice Address - Phone:321-724-0394
Practice Address - Fax:327-952-2516
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW00015461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ2938Medicare ID - Type UnspecifiedBCBS PROVIDER NUMBER