Basic Information
| Provider Information | |||||||||
| NPI: | 1134115538 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | POSSIBILITIES COUNSELING SERVICES PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4741 NE 27TH AVE | ||||||||
| Address2: | |||||||||
| City: | FORT LAUDERDALE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333084818 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9548956031 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1975 E SUNRISE BLVD | ||||||||
| Address2: | STE 513 | ||||||||
| City: | FORT LAUDERDALE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333041433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9548956031 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | ROSEMAN | ||||||||
| AuthorizedOfficialFirstName: | SHARON | ||||||||
| AuthorizedOfficialMiddleName: | DEBRA | ||||||||
| AuthorizedOfficialTitleorPosition: | LICENSED CLINICAL SOCIAL WORKER | ||||||||
| AuthorizedOfficialTelephone: | 9548956031 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | L.C.S.W. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | SW 6683 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | Z018D | 01 | FL | BLUECROSSBLUESHIELD | OTHER | 214677 | 01 | COMPSYCH | OTHER | 294774 | 01 | AVMED | OTHER |