Healthcare Provider Details

I. General information

NPI: 1750945689
Provider Name (Legal Business Name): ISABEL TAYLOR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2019
Last Update Date: 07/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 W FLAGLER ST STE 310
MIAMI FL
33135-2099
US

IV. Provider business mailing address

2790 RIVER RUN CIR E
MIRAMAR FL
33025-4429
US

V. Phone/Fax

Practice location:
  • Phone: 786-467-7006
  • Fax: 786-999-0971
Mailing address:
  • Phone: 786-575-3801
  • Fax: 954-342-9163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. TABITHA SHERELLE TAYLOR-BOONE
Title or Position: CLINICAL SOCIAL WORKER
Credential: LCSW
Phone: 786-575-3801