Healthcare Provider Details

I. General information

NPI: 1457878647
Provider Name (Legal Business Name): ANTHONY WILLIAM JERRIDO LMHC, MCAP, SAP, CAP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2017
Last Update Date: 02/25/2026
Certification Date: 02/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 S STATE ROAD 7 STE 223
MIRAMAR FL
33023-7206
US

IV. Provider business mailing address

10700 CITY CENTER BLVD APT 5104
PEMBROKE PINES FL
33025-4082
US

V. Phone/Fax

Practice location:
  • Phone: 786-222-5363
  • Fax:
Mailing address:
  • Phone: 786-222-5363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberMCAP.0101178
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number2486
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH20179
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: