Healthcare Provider Details

I. General information

NPI: 1790330504
Provider Name (Legal Business Name): CONNECTED WARRIORS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2019
Last Update Date: 07/25/2022
Certification Date: 07/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21301 POWERLINE RD STE 106
BOCA RATON FL
33433-2389
US

IV. Provider business mailing address

21301 POWERLINE RD STE 106
BOCA RATON FL
33433-2389
US

V. Phone/Fax

Practice location:
  • Phone: 954-278-3764
  • Fax: 561-295-4009
Mailing address:
  • Phone: 954-278-3764
  • Fax: 561-295-4009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State

VIII. Authorized Official

Name: JUDY LYNN WEAVER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 954-278-3764