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General NPI Number Information
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NPI Number | 1588027262
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Entity Type | Organization
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Legal Business Name | KIDS CONNECTION OF FT LAUDERDALE
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Dates
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Enumeration Date | 03/31/2016
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Last Update Date | 03/31/2016
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Provider Practice Location Address
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Address Line | 1711 NE 3RD CT
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City | FT LAUDERDALE
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State | FL
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Zip | 33301-3811
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Country | US
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Telephone | 775-240-4124
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Fax |
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Provider Business Mailing Address
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Address Line | 1711 NE 3RD CT
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City | FT LAUDERDALE
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State | FL
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Zip | 33301-3811
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Country | US
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Telephone | 775-240-4124
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Fax |
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Authorized Official
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Title or Position | OWNER/CEO
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Name | MS. STEPHANIE KANE
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Credential | LMHC, LMFT
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Telephone | 775-240-4124
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | MH 13853
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License Number State | FL
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