Healthcare Provider Details

I. General information

NPI: 1497659049
Provider Name (Legal Business Name): KOREEN AMOY ANDERSON ISW24001
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7425 NW 52ND ST
LAUDERHILL FL
33319-6314
US

IV. Provider business mailing address

7425 NW 52ND ST
LAUDERHILL FL
33319-6314
US

V. Phone/Fax

Practice location:
  • Phone: 754-366-2159
  • Fax:
Mailing address:
  • Phone: 754-366-2159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW24001
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: