MEDICARE: WESTSIDE THERAPY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1114526670
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESTSIDE THERAPY

Provider Business Mailing Address
First Line	:	4313 GOLFERS CIR E
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-4609
Country	:	US
Telephone Number	:	561-214-4113
Fax Number	:

Provider Business Practice Location Address
First Line	:	4313 GOLFERS CIR E
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-4609
Country	:	US
Telephone Number	:	561-214-4113
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JORDAN ZIPKIN
Credential	:	LMFT
Telephone Number	:	561-214-4113

Provider Enumeration Date	:	10/25/2020
Last Update Date	:	10/25/2020

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Directions to “WESTSIDE THERAPY ” Practice Location

Language	Start Address	Practice Location

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