MEDICARE: AMANICK BOOTHE LCSW

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	1041C0700X	Clinical Social Worker	CSW010062	GA
2	1041C0700X	Clinical Social Worker	1615	SC
3	101YM0800X	Mental Health Counselor
4	1041C0700X	Clinical Social Worker	SW24447	FL

General Provider Information

NPI Number	:	1992584312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANICK BOOTHE LCSW

Provider Business Mailing Address
First Line	:	7777 DAVIE ROAD EXT STE 302B
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33024-2503
Country	:	US
Telephone Number	:	954-852-1997
Fax Number	:	954-852-1998

Provider Business Practice Location Address
First Line	:	7777 DAVIE ROAD EXT STE 302B
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33024-2503
Country	:	US
Telephone Number	:	954-852-1997
Fax Number	:	954-852-1998

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/25/2023
Last Update Date	:	06/08/2026

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