MEDICARE: MR. ROBERT MICHAEL COLE LMHC, RD, LDN

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	MH7315	FL
2	133V00000X	Registered Dietitian	ND39	FL

General Provider Information

NPI Number	:	1629287644
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT MICHAEL COLE LMHC, RD, LDN

Provider Business Mailing Address
First Line	:	3001 NE 21ST TER
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33306-1219
Country	:	US
Telephone Number	:	954-200-3607
Fax Number	:

Provider Business Practice Location Address
First Line	:	3411 NW 9TH AVE
Second Line	:	SUITE 704
City	:	OAKLAND PARK
State	:	FL
Zip	:	33309-5946
Country	:	US
Telephone Number	:	954-200-3607
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	03/25/2016

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