MEDICARE: FOUNDATIONS FOR L.I.F.E.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1477292118
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOUNDATIONS FOR L.I.F.E.

Provider Business Mailing Address
First Line	:	6928 NW 30TH AVE
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-1337
Country	:	US
Telephone Number	:	954-594-6816
Fax Number	:

Provider Business Practice Location Address
First Line	:	6928 NW 30TH AVE # 6928
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-1337
Country	:	US
Telephone Number	:	954-947-1247
Fax Number	:

Authorized Official
Title or Position	:	LICENSED MARRIAGE & FAMILY THERAPIS
Name	:	ANDROMEDA MOODIE
Credential	:	LMFT
Telephone Number	:	954-594-6816

Provider Enumeration Date	:	06/01/2022
Last Update Date	:	06/01/2022

Similar Medicare Providers

1255848628 — ANDROMEDA MOODIE LMFT
Practice Location Address:

6928 NW 30TH AVE STE 6928
FORT LAUDERDALE, FL
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Practice Fax:

1902270572 — HECTOR RUBIO
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1104829118 — DR. KENNETH BILLINGS ALLEN D.D.S.
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1730171935 — DR. NATHAN W SCHAFFNER DDS
Practice Location Address:

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1558474346 — DR. GREG LEE CRAWFORD D.C.
Practice Location Address:

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1154494920 — KENNETH AUSTIN HOWIE D.D.S.
Practice Location Address:

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Practice Fax: 970-482-7562

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