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General NPI Number Information
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NPI Number | 1114202728
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Entity Type | Organization
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Legal Business Name | MYSELF DISCOVERY, LLC
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Dates
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Enumeration Date | 10/14/2011
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Last Update Date | 12/12/2011
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Provider Practice Location Address
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Address Line | 400 SE 12TH ST
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City | FT LAUDERDALE
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State | FL
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Zip | 33316-1937
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Country | US
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Telephone | 954-524-2217
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Fax |
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Provider Business Mailing Address
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Address Line | 400 SE 12TH ST
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City | FT LAUDERDALE
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State | FL
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Zip | 33316-1937
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Country | US
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Telephone | 954-524-2217
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DEBBY GOTTLIEB
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Credential | LCSW
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Telephone | 954-328-5429
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW10552
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | SW10552
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License Number State | FL
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