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General NPI Number Information
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NPI Number | 1861724692
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Entity Type | Organization
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Legal Business Name | EXCEPTIONAL SERVICES GROUP, LLC
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Dates
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Enumeration Date | 02/03/2010
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Last Update Date | 12/21/2016
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Provider Practice Location Address
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Address Line | 9070 KIMBERLY BLVD SUITE 50
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City | BOCA RATON
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State | FL
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Zip | 33434-2855
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Country | US
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Telephone | 561-852-0910
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Fax | 561-852-0960
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Provider Business Mailing Address
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Address Line | 9070 KIMBERLY BLVD SUITE 50
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City | BOCA RATON
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State | FL
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Zip | 33434-2855
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Country | US
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Telephone | 561-852-0910
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Fax | 561-852-0960
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JUSTIN VASSI
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Credential | L.C.S.W.
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Telephone | 561-852-0910
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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 | SW9737
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License Number State | FL
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