Healthcare Provider Details

I. General information

NPI: 1609548668
Provider Name (Legal Business Name): CAROLYN SHAPIR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2021
Last Update Date: 09/29/2021
Certification Date: 09/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 N DIXIE HWY
POMPANO BEACH FL
33060-5621
US

IV. Provider business mailing address

3195 WILLOW LN
WESTON FL
33331-3031
US

V. Phone/Fax

Practice location:
  • Phone: 954-785-8285
  • Fax:
Mailing address:
  • Phone: 954-649-7140
  • Fax: 954-384-0701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: