Healthcare Provider Details

I. General information

NPI: 1386903482
Provider Name (Legal Business Name): LORI SARVIS , LCSW PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2012
Last Update Date: 06/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2151 W HILLSBORO BLVD STE 203
DEERFIELD BCH FL
33442-1275
US

IV. Provider business mailing address

2151 W HILLSBORO BLVD STE 203
DEERFIELD BCH FL
33442-1275
US

V. Phone/Fax

Practice location:
  • Phone: 954-426-0410
  • Fax: 954-596-4822
Mailing address:
  • Phone: 954-426-0410
  • Fax: 954-596-4822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License NumberSW0002627
License Number StateFL

VIII. Authorized Official

Name: LORI SARVIS
Title or Position: LCSW, PA
Credential: LCSW
Phone: 954-426-0410