Healthcare Provider Details

I. General information

NPI: 1720782584
Provider Name (Legal Business Name): PROSPER HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2023
Last Update Date: 08/24/2023
Certification Date: 08/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

382 COCONUT CIR
WESTON FL
33326-3317
US

IV. Provider business mailing address

254 W 18TH ST APT 2
NEW YORK NY
10011-4526
US

V. Phone/Fax

Practice location:
  • Phone: 954-599-4313
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: BENJAMIN SCHECTER
Title or Position: PRACTICE MANAGER
Credential:
Phone: 954-599-4313