MEDICARE: UNITY N DIVERSITY PSYCHOTHERAPY, LLC

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1619824695
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNITY N DIVERSITY PSYCHOTHERAPY, LLC

Provider Business Mailing Address
First Line	:	1375 GATEWAY BLVD
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33426-8304
Country	:	US
Telephone Number	:	561-206-4640
Fax Number	:

Provider Business Practice Location Address
First Line	:	1375 GATEWAY BLVD
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33426-8304
Country	:	US
Telephone Number	:	561-206-4640
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	MICHAEL C JAMES
Credential	:	LCSW
Telephone Number	:	561-206-4640

Provider Enumeration Date	:	03/11/2026
Last Update Date	:	03/11/2026

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