Healthcare Provider Details

I. General information

NPI: 1831029016
Provider Name (Legal Business Name): JOURNEY PSYCHOLOGY SERVICES & CONSULTING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11011 SHERIDAN ST STE 211
HOLLYWOOD FL
33026-1531
US

IV. Provider business mailing address

11011 SHERIDAN ST STE 211
HOLLYWOOD FL
33026-1531
US

V. Phone/Fax

Practice location:
  • Phone: 954-408-2367
  • Fax:
Mailing address:
  • Phone: 954-408-2367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: FERNANDE NANDA MAMANE
Title or Position: LICENSED CLINICAL PSYCHOLOGIST
Credential: PHD
Phone: 954-408-2367