Healthcare Provider Details

I. General information

NPI: 1588171516
Provider Name (Legal Business Name): VIRGINIA A ERDIE ATR-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2017
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2035 DEWEY ST # 2
HOLLYWOOD FL
33020-6923
US

IV. Provider business mailing address

4302 HOLLYWOOD BLVD # 1010
HOLLYWOOD FL
33021-6635
US

V. Phone/Fax

Practice location:
  • Phone: 305-409-1662
  • Fax:
Mailing address:
  • Phone: 305-409-1662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number95-090
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number95-090
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: