Back Door, LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

SW8039 Issued in FL

Legal business name

BACK DOOR, LLC

Practice address

1639 Cape Coral Pkwy E Ste 211
Cape Coral, FL 33904-9657

Phone

(239) 745-5917

Fax

(866) 676-2762

NPI assigned

Aug 18, 2009

Last updated

Nov 17, 2009By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Cheryl L Buss, LCSW

Title

Managing Member

Phone

(239) 745-5917

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1250553600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1258416000000",
    "number": "1982836391",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1639 CAPE CORAL PKWY E STE 211",
            "city": "CAPE CORAL",
            "state": "FL",
            "postal_code": "339049657",
            "telephone_number": "239-745-5917",
            "fax_number": "866-676-2762"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1639 CAPE CORAL PKWY E STE 211",
            "city": "CAPE CORAL",
            "state": "FL",
            "postal_code": "339049657",
            "telephone_number": "239-745-5917",
            "fax_number": "866-676-2762"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BACK DOOR, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-08-18",
        "last_updated": "2009-11-17",
        "status": "A",
        "authorized_official_last_name": "BUSS",
        "authorized_official_first_name": "CHERYL",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "239-745-5917",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW8039",
            "primary": true
        },
        {
            "code": "103TP0016X",
            "taxonomy_group": "",
            "desc": "Psychologist, Prescribing (Medical)",
            "state": "FL",
            "license": "ME100060",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Victoria Badillo
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• Clinical Social Worker in Cape Coral, FL
• Providers in Cape Coral, 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 Nov 17, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.