Progressive Healthcare of Brevard, LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

PROGRESSIVE HEALTHCARE OF BREVARD, LLC

Practice address

5972 Goleta Cir
Melbourne, FL 32940-8035

Phone

(321) 615-0990

Fax

(888) 341-8272

NPI assigned

Jan 13, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Gwen Mundorf, LCSWNPI 1295967776

Title

Therapist

Phone

(321) 615-0990

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Gwen Mundorf, MSW, LCSW

  • Clinical Social Worker
  • Melbourne, FL
  • NPI 1295967776
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1578873600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1578873600000",
    "number": "1134769698",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5972 GOLETA CIR",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329408035",
            "telephone_number": "321-615-0990",
            "fax_number": "888-341-8272"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5972 GOLETA CIR",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329408035",
            "telephone_number": "321-615-0990",
            "fax_number": "888-341-8272"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROGRESSIVE HEALTHCARE OF BREVARD, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-13",
        "last_updated": "2020-01-13",
        "certification_date": "2020-01-13",
        "status": "A",
        "authorized_official_last_name": "MUNDORF",
        "authorized_official_first_name": "GWEN",
        "authorized_official_title_or_position": "THERAPIST",
        "authorized_official_telephone_number": "321-615-0990",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "gwenmundorf@cfl.rr.com",
            "affiliation": "N",
            "endpointDescription": "Secure email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Secure email",
            "address_1": "5972 Goleta Cir",
            "city": "Melbourne",
            "state": "FL",
            "country_code": "US",
            "postal_code": "329408035",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Clinical Social Worker in Melbourne, FL
• Providers in Melbourne, FL by specialty
• Clinical Social Worker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.