Healthcare Provider Details

I. General information

NPI: 1790558195
Provider Name (Legal Business Name): NOW CHANGE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2023
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 S UNIVERSITY DR STE 303
DAVIE FL
33328-3841
US

IV. Provider business mailing address

8350 SW 41ST CT
DAVIE FL
33328-2944
US

V. Phone/Fax

Practice location:
  • Phone: 754-304-6378
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARIANELA PENA-MARTINEZ
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PSY.D.
Phone: 754-304-6378