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General NPI Number Information
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NPI Number | 1205286002
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Entity Type | Organization
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Legal Business Name | BREAKWATER PSYCHOLOGICAL TRAUMA & WELLNESS GROUP, LLC
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Dates
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Enumeration Date | 06/13/2016
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Last Update Date | 06/13/2016
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Provider Practice Location Address
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Address Line | 6971 N FEDERAL HWY SUITE 301
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City | BOCA RATON
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State | FL
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Zip | 33487-1656
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Country | US
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Telephone | 754-444-6313
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Fax |
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Provider Business Mailing Address
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Address Line | 1198 HILLSBORO MILE UNIT 316
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City | HILLSBORO BEACH
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State | FL
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Zip | 33062-1530
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Country | US
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Telephone | 754-444-6313
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | BART PLASKOFF
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Credential | M.ED.,MSW,EMDR,RCSWI
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Telephone | 754-444-6313
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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 | ISW9679
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License Number State | FL
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