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General NPI Number Information
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NPI Number | 1154955466
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Entity Type | Organization
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Legal Business Name | MY SOCIAL CIRCLE THERAPY INC
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Dates
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Enumeration Date | 02/25/2020
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Last Update Date | 07/21/2023
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Provider Practice Location Address
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Address Line | 12145 SW 3RD ST
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City | PEMBROKE PINES
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State | FL
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Zip | 33025-5919
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Country | US
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Telephone | 786-506-6240
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Fax |
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Provider Business Mailing Address
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Address Line | 12145 SW 3RD ST
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City | PEMBROKE PINES
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State | FL
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Zip | 33025-5919
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Country | US
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Telephone | 786-797-0283
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. CAROLINA OTERO
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Credential | M.S.
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Telephone | 786-797-0283
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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