1982763413 NPI number — MRS. SHLOMIT MATAN KARASIK L.C.S.W

Table of content: MRS. SHLOMIT MATAN KARASIK L.C.S.W (NPI 1982763413)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982763413 NPI number — MRS. SHLOMIT MATAN KARASIK L.C.S.W

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KARASIK
Provider First Name:
SHLOMIT
Provider Middle Name:
MATAN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
L.C.S.W
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:
1982763413
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/28/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15204 S JOG RD
Provider Second Line Business Mailing Address:
STE 303
Provider Business Mailing Address City Name:
DELRAY BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33446-2171
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-503-3059
Provider Business Mailing Address Fax Number:
561-634-2776

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7700 CONGRESS AVE STE 1131
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOCA RATON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33487-1355
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-675-8465
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/08/2006

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: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 103003300 . 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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