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General NPI Number Information
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NPI Number | 1568553402
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Entity Type | Individual
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Provider Name | RICHARD CHARLES LMFT
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Gender | Male
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 10031 PINES BLVD STE 248
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City | PEMBROKE PINES
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State | FL
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Zip | 33024-6180
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Country | US
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Telephone | 754-229-5912
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Fax | 413-618-3929
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Provider Business Mailing Address
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Address Line | 3608 SW 58TH AVE
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City | WEST PARK
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State | FL
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Zip | 33023-6131
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Country | US
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Telephone | 305-496-7531
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Fax | 413-618-3929
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MT2029
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License Number State | FL
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