Healthcare Provider Details

I. General information

NPI: 1982570362
Provider Name (Legal Business Name): SIVAN YECHEZKEL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2025
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2124 NE 123RD ST STE 220
NORTH MIAMI FL
33181-2939
US

IV. Provider business mailing address

3000 NE 188TH ST APT 503
AVENTURA FL
33180-2986
US

V. Phone/Fax

Practice location:
  • Phone: 786-828-0947
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW25490
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: