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General NPI Number Information
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NPI Number | 1912241571
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Entity Type | Organization
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Legal Business Name | MARK SANDVOSS LLC
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Dates
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Enumeration Date | 11/20/2012
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Last Update Date | 11/20/2012
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Provider Practice Location Address
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Address Line | 1505 N UNIVERSITY DR SUITE 403
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City | CORAL SPRINGS
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State | FL
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Zip | 33071-8921
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Country | US
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Telephone | 954-362-3590
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Fax | 954-362-3589
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Provider Business Mailing Address
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Address Line | 1505 N UNIVERSITY DR SUITE 403
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City | CORAL SPRINGS
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State | FL
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Zip | 33071-8921
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Country | US
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Telephone | 954-362-3590
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Fax | 954-362-3589
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | MR. MARK T SANDVOSS
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Credential | L.C.S.W.
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Telephone | 954-362-3590
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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 | SW 7743
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License Number State | FL
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