Healthcare Provider Details

I. General information

NPI: 1710232756
Provider Name (Legal Business Name): MARLA SRISKAND LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2012
Last Update Date: 12/17/2019
Certification Date: 12/17/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 N FEDERAL HWY
POMPANO BEACH FL
33062-4315
US

IV. Provider business mailing address

12700 NW 8TH CT
CORAL SPRINGS FL
33071-4409
US

V. Phone/Fax

Practice location:
  • Phone: 954-533-7705
  • Fax: 954-781-7191
Mailing address:
  • Phone: 954-632-1203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW 8803
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberSW8803
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: