Healthcare Provider Details

I. General information

NPI: 1154943629
Provider Name (Legal Business Name): SOCIAL SCIENCE AND RESEARCH CONSULTANTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2020
Last Update Date: 05/07/2020
Certification Date: 05/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3856 SW 52ND AVE
HOLLYWOOD FL
33023-6905
US

IV. Provider business mailing address

PO BOX 814358
HOLLYWOOD FL
33081-4358
US

V. Phone/Fax

Practice location:
  • Phone: 786-246-7121
  • Fax: 707-443-3204
Mailing address:
  • Phone: 786-246-7121
  • Fax: 707-443-3204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. DEANNE MICHELE SAMUELS
Title or Position: OWNER
Credential: PHD
Phone: 786-246-7121