Healthcare Provider Details

I. General information

NPI: 1457373649
Provider Name (Legal Business Name): MICHELLE THOMAS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 04/30/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5925 MCKINLEY ST
HOLLYWOOD FL
33021-4560
US

IV. Provider business mailing address

10001 W OAKLAND PARK BLVD
SUNRISE FL
33351-6925
US

V. Phone/Fax

Practice location:
  • Phone: 954-963-0991
  • Fax: 954-963-3956
Mailing address:
  • Phone: 954-963-0991
  • Fax: 954-963-3956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: