MEDICARE: EMDR UNLOCKED 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	:	1649126558
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMDR UNLOCKED LLC

Provider Business Mailing Address
First Line	:	5000 CHARDONNAY DR
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33067-4122
Country	:	US
Telephone Number	:	617-286-5581
Fax Number	:	781-386-2591

Provider Business Practice Location Address
First Line	:	5000 CHARDONNAY DR
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33067-4122
Country	:	US
Telephone Number	:	617-286-5581
Fax Number	:	781-386-2591

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. SHERLY MILLAN
Credential	:	LICSW
Telephone Number	:	954-778-7025

Provider Enumeration Date	:	03/05/2026
Last Update Date	:	03/05/2026

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