Healthcare Provider Details

I. General information

NPI: 1992660294
Provider Name (Legal Business Name): TALIA GOLDWYN LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21286 HARROW CT
BOCA RATON FL
33433-7400
US

IV. Provider business mailing address

21286 HARROW CT
BOCA RATON FL
33433-7400
US

V. Phone/Fax

Practice location:
  • Phone: 754-333-0942
  • Fax:
Mailing address:
  • Phone: 754-333-0942
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number016437
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH26307
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: