=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184043135
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WOOLMAN & ASSOCIATES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/07/2014
-----------------------------------------------------
Last Update Date | 04/07/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10631 N KENDALL DR EXECUTIVE CENTER SUITE 1201
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33176-1568
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-412-0027
-----------------------------------------------------
Fax | 305-595-1866
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10631 N KENDALL DR EXECUTIVE CENTER SUITE 1201
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33176-1568
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-412-0027
-----------------------------------------------------
Fax | 305-595-1866
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CONSULTING PSYCHOLOGIST/OWNER
-----------------------------------------------------
Name | DR. JOHANNA WOOLMAN
-----------------------------------------------------
Credential | PSY.D.
-----------------------------------------------------
Telephone | 305-412-0027
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------