Healthcare Provider Details

I. General information

NPI: 1679202246
Provider Name (Legal Business Name): SEASONS PSYCHOTHERAPY ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2022
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 E OAKLAND PARK BLVD STE 205
FORT LAUDERDALE FL
33306-1658
US

IV. Provider business mailing address

2601 E OAKLAND PARK BLVD STE 205
FORT LAUDERDALE FL
33306-1658
US

V. Phone/Fax

Practice location:
  • Phone: 954-342-0982
  • Fax: 954-342-1080
Mailing address:
  • Phone: 954-342-0982
  • Fax: 954-342-1080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: DANIEL MIRONES
Title or Position: COO
Credential:
Phone: 954-342-6322