Provider Demographics
NPI:1669735106
Name:DEPARTMENT OF VETERANS AFFAIRS
Entity type:Organization
Organization Name:DEPARTMENT OF VETERANS AFFAIRS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:ALETA
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:239-939-3939
Mailing Address - Street 1:3033 WINKLER AVE EXT
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33916-9413
Mailing Address - Country:US
Mailing Address - Phone:239-939-3939
Mailing Address - Fax:239-931-6107
Practice Address - Street 1:3033 WINKLER AVE EXT
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33916-9413
Practice Address - Country:US
Practice Address - Phone:239-939-3939
Practice Address - Fax:239-931-6107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-20
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51184273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit