Healthcare Provider Details

I. General information

NPI: 1093349185
Provider Name (Legal Business Name): PHILIP SOLOMON AND ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2020
Last Update Date: 02/27/2020
Certification Date: 02/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4699 N FEDERAL HWY # 102F
POMPANO BEACH FL
33064-6510
US

IV. Provider business mailing address

4699 N FEDERAL HWY # 102F
POMPANO BEACH FL
33064-6510
US

V. Phone/Fax

Practice location:
  • Phone: 954-210-6070
  • Fax: 888-900-2325
Mailing address:
  • Phone: 954-210-6070
  • Fax: 888-900-2325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: PHILIP SOLOMON
Title or Position: PRESIDENT
Credential:
Phone: 954-210-6070