Healthcare Provider Details

I. General information

NPI: 1629597174
Provider Name (Legal Business Name): MARTIN LEWIS PERCHER LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2017
Last Update Date: 01/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 N PARK RD STE 400
HOLLYWOOD FL
33021-6918
US

IV. Provider business mailing address

3265 NW 47TH AVE # 3211
COCONUT CREEK FL
33063-1803
US

V. Phone/Fax

Practice location:
  • Phone: 954-925-3191
  • Fax: 954-925-3193
Mailing address:
  • Phone: 954-732-0440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW3624
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: