MEDICARE: CATHY PONCZEK LMFT, CAP

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	106H00000X	Marriage & Family Therapist	MT2314	FL

General Provider Information

NPI Number	:	1649597659
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHY PONCZEK LMFT, CAP

Provider Business Mailing Address
First Line	:	9730 NW 63RD PL
Second Line	:
City	:	PARKLAND
State	:	FL
Zip	:	33076-1806
Country	:	US
Telephone Number	:	954-398-0714
Fax Number	:	954-753-3125

Provider Business Practice Location Address
First Line	:	4699 N FEDERAL HWY
Second Line	:	SUITE #101A
City	:	POMPANO BEACH
State	:	FL
Zip	:	33064-6510
Country	:	US
Telephone Number	:	954-790-4420
Fax Number	:	954-753-3125

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

Provider Enumeration Date	:	04/29/2010
Last Update Date	:	03/26/2012

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