=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750617999
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FRIENDS OF CHILDREN
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/22/2009
-----------------------------------------------------
Last Update Date | 10/22/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3500 N STATE ROAD 7 STE 211
-----------------------------------------------------
City | LAUDERDALE LAKES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33319-5625
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-578-0523
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3500 N STATE ROAD 7 STE 211
-----------------------------------------------------
City | LAUDERDALE LAKES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33319-5625
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-457-7598
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MRS. DAVINA CRUSHANK BROWN
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 305-457-7598
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 302F00000X
-----------------------------------------------------
Taxonomy Name | Exclusive Provider Organization
-----------------------------------------------------
License Number | ISW4315
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------