=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285265280
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SPARROW COUNSELING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/28/2020
-----------------------------------------------------
Last Update Date | 06/21/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 44320 PEMBROKE RD.
-----------------------------------------------------
City | WEST PARK
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33021
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 754-201-1342
-----------------------------------------------------
Fax | 833-283-2424
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3520 SW 36TH CT
-----------------------------------------------------
City | WEST PARK
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33023-6346
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. ALFREDO RIVERA JR.
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 863-660-9581
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------