Healthcare Provider Details

I. General information

NPI: 1760463236
Provider Name (Legal Business Name): DR STANLEY AND PEARL GOODMAN JFS OF BROWARD COUNTY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 09/20/2024
Certification Date: 09/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5890 S PINE ISLAND RD STE 201
DAVIE FL
33328-5936
US

IV. Provider business mailing address

5890 S PINE ISLAND RD STE 201
DAVIE FL
33328-5936
US

V. Phone/Fax

Practice location:
  • Phone: 954-370-2140
  • Fax: 954-916-1252
Mailing address:
  • Phone: 954-370-2140
  • Fax: 954-916-1252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MR. RANDY COLEMAN
Title or Position: PRESIDENT & CEO
Credential:
Phone: 954-370-2140