Healthcare Provider Details

I. General information

NPI: 1316128887
Provider Name (Legal Business Name): FRONA P ISRAEL MSW BBA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2007
Last Update Date: 05/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2225 N UNIVERSITY DR
PEMBROKE PINES FL
33024-3611
US

IV. Provider business mailing address

2225 N. UNIVERSITY DRIVE
PEMBROKE PINES FL
33024-3661
US

V. Phone/Fax

Practice location:
  • Phone: 954-962-6200
  • Fax: 954-962-5495
Mailing address:
  • Phone: 305-494-3555
  • Fax: 954-962-5495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberSAP80608
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW5767
License Number StateFL

VIII. Authorized Official

Name: FRONA P. ISRAEL
Title or Position: PRESIDENT
Credential: LCSW DCFC SAP
Phone: 305-494-3555