Healthcare Provider Details

I. General information

NPI: 1699264184
Provider Name (Legal Business Name): MICHAEL ROISMAN MSW, CAP, ICADC, SAP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2018
Last Update Date: 10/20/2020
Certification Date: 10/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7520 SW 57TH AVE STE D
SOUTH MIAMI FL
33143-5330
US

IV. Provider business mailing address

10041 SW 144TH ST
MIAMI FL
33176-7083
US

V. Phone/Fax

Practice location:
  • Phone: 305-710-5288
  • Fax:
Mailing address:
  • Phone: 305-926-8510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberADC-009399-2015
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number804596
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number16360816
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW17581
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: