Healthcare Provider Details

I. General information

NPI: 1235935818
Provider Name (Legal Business Name): TIKKUN THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2025
Last Update Date: 02/27/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 N FEDERAL HWY STE 210
BOCA RATON FL
33431-5195
US

IV. Provider business mailing address

4400 NORTH MEMORIAL HIGHWAY SUITE 210
BOCA RATON FL
33431
US

V. Phone/Fax

Practice location:
  • Phone: 561-789-9359
  • Fax:
Mailing address:
  • Phone: 561-789-9359
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN BELOLO
Title or Position: OWNER
Credential:
Phone: 561-789-9359