Organization Name: | EM LEGACY LLC |
NPI Number: | 1386056984 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ERIN M PORTER (MNGR DIRECTOR) |
Mailing Address: | 2605 72nd Ave E 221 Ellenton |
State: | FL US |
Postal Code: | 342227000 |
Phone Number: | 9415459630 |
Fax Number: | |
NPI Enumeration Date: | 05/30/2014 |
NPI Last Update Date: | 05/30/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | SW11139 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |