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General NPI Number Information
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NPI Number | 1588007652
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Entity Type | Organization
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Legal Business Name | SAGAMORE SCHOOL, LLC
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Dates
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Enumeration Date | 04/09/2013
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Last Update Date | 04/09/2013
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Provider Practice Location Address
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Address Line | 6820 LYONS TECHNOLOGY PKWY SUITE 230
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City | COCONUT CREEK
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State | FL
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Zip | 33073-4314
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Country | US
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Telephone | 954-420-9566
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Fax | 954-905-4382
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Provider Business Mailing Address
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Address Line | 6820 LYONS TECHNOLOGY CIRCLE SUITE 230
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City | COCONUT CREEK
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State | FL
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Zip | 33073
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Country | US
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Telephone | 954-420-9566
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Fax | 954-905-4382
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Authorized Official
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Title or Position | CO-OWNER
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Name | DR. LISA RACHEL GROSSMAN
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Credential | E.D.D., CCC-SLP
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Telephone | 954-420-9566
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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 | SW9748
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MT1955
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SA7678
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SA4869
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License Number State | FL
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Taxonomy #5
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SA10302
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License Number State | FL
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Taxonomy #6
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SA5302
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License Number State | FL
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