MEDICARE: JW THERAPY LLC

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	101YM0800X	Mental Health Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548884083
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JW THERAPY LLC

Provider Business Mailing Address
First Line	:	8330 NW 53RD CT
Second Line	:
City	:	LAUDERHILL
State	:	FL
Zip	:	33351-4918
Country	:	US
Telephone Number	:	954-821-9705
Fax Number	:	954-252-2084

Provider Business Practice Location Address
First Line	:	7481 W OAKLAND PARK BLVD STE 302H
Second Line	:
City	:	TAMARAC
State	:	FL
Zip	:	33319-4961
Country	:	US
Telephone Number	:	954-821-9705
Fax Number	:	954-252-2084

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JEROME WASHINGTON
Credential	:	LMHC
Telephone Number	:	954-821-9705

Provider Enumeration Date	:	06/01/2020
Last Update Date	:	06/01/2020

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Directions to “JW THERAPY LLC ” Practice Location

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