Healthcare Provider Details

I. General information

NPI: 1790608933
Provider Name (Legal Business Name): TARYN RENEE BOOTH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TARYN RENEE SADWICK

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22455 BOCA RIO RD
BOCA RATON FL
33433-4708
US

IV. Provider business mailing address

20 NE 18TH AVE
POMPANO BEACH FL
33060-6736
US

V. Phone/Fax

Practice location:
  • Phone: 561-483-5300
  • Fax:
Mailing address:
  • Phone: 754-302-6553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH28094
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: