Healthcare Provider Details

I. General information

NPI: 1790600187
Provider Name (Legal Business Name): FOSTER PSYCHIATRIC WELLNESS GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3345 NW 21ST ST
LAUDERDALE LAKES FL
33311-2711
US

IV. Provider business mailing address

3345 NW 21ST ST
LAUDERDALE LAKES FL
33311-2711
US

V. Phone/Fax

Practice location:
  • Phone: 786-692-5369
  • Fax: 954-717-0693
Mailing address:
  • Phone: 786-692-5369
  • Fax: 954-717-0693

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. LISA MAY FOSTER
Title or Position: FOUNDER & CEO
Credential: DNP, APRN, PMHNP-BC
Phone: 786-692-5369