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General NPI Number Information
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NPI Number | 1649597659
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Entity Type | Individual
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Provider Name | CATHY PONCZEK LMFT, CAP
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Gender | Female
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Dates
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Enumeration Date | 04/29/2010
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Last Update Date | 03/26/2012
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Provider Practice Location Address
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Address Line | 4699 N FEDERAL HWY SUITE #101A
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City | POMPANO BEACH
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State | FL
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Zip | 33064-6510
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Country | US
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Telephone | 954-790-4420
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Fax | 954-753-3125
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Provider Business Mailing Address
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Address Line | 9730 NW 63RD PL
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City | PARKLAND
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State | FL
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Zip | 33076-1806
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Country | US
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Telephone | 954-398-0714
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Fax | 954-753-3125
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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 | MT2314
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License Number State | FL
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