=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093915043
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DIFFERENT LIKE ME INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/18/2007
-----------------------------------------------------
Last Update Date | 11/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7000 W PALMETTO PARK RD STE 201
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33433-3430
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-270-2280
-----------------------------------------------------
Fax | 561-270-2284
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 702 LUMPKIN ST
-----------------------------------------------------
City | TRAVELERS REST
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29690-1983
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-270-2280
-----------------------------------------------------
Fax | 561-270-2284
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ALYSE NOVEMBER
-----------------------------------------------------
Credential | PHD, LCSW
-----------------------------------------------------
Telephone | 561-270-2280
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | SW7605
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------