Healthcare Provider Details

I. General information

NPI: 1881127322
Provider Name (Legal Business Name): SANDRA SEYMOUR OBAS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2017
Last Update Date: 02/28/2023
Certification Date: 02/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2875 NE 191ST ST STE 500
AVENTURA FL
33180-2832
US

IV. Provider business mailing address

2875 NE 191ST ST STE 500
AVENTURA FL
33180-2832
US

V. Phone/Fax

Practice location:
  • Phone: 305-725-2548
  • Fax:
Mailing address:
  • Phone: 305-725-2548
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW20037
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: