1215073986 NPI number — DR. FAITH MONICA BIRD EDD, LMHC, CAP

Table of content: DR. FAITH MONICA BIRD EDD, LMHC, CAP (NPI 1215073986)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215073986 NPI number — DR. FAITH MONICA BIRD EDD, LMHC, CAP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BIRD
Provider First Name:
FAITH
Provider Middle Name:
MONICA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
EDD, LMHC, CAP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215073986
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/25/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1876 N UNIVERSITY DR
Provider Second Line Business Mailing Address:
SUITE 200-C
Provider Business Mailing Address City Name:
PLANTATION
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33322-4130
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-472-2377
Provider Business Mailing Address Fax Number:
954-888-1744

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1876 N UNIVERSITY DR
Provider Second Line Business Practice Location Address:
SUITE 200-C
Provider Business Practice Location Address City Name:
PLANTATION
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33322-4130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-472-2377
Provider Business Practice Location Address Fax Number:
954-888-1744
Provider Enumeration Date:
01/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  CAP 2012 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: MH 7548 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 270104313 . This is a "TAX IDENTIFICATION NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 108598900 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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