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General NPI Number Information
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NPI Number | 1326177411
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Entity Type | Individual
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Provider Name | TRISHA ANN MODZELEWSKI LMHC
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Gender | Female
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 02/27/2023
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Provider Practice Location Address
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Address Line | 9703 NW 16TH ST
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City | PEMBROKE PINES
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State | FL
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Zip | 33024-4474
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Country | US
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Telephone | 954-756-5491
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Fax |
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Provider Business Mailing Address
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Address Line | 8570 STIRLING RD STE 102-105
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City | HOLLYWOOD
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State | FL
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Zip | 33024-8203
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Country | US
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Telephone | 954-756-5491
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | MH7123
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License Number State | FL
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