MEDICARE: EVOLVE THERAPEUTIC SOLUTIONS 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	:	1699524249
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVOLVE THERAPEUTIC SOLUTIONS LLC

Provider Business Mailing Address
First Line	:	1531 NW 173RD TER
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33169-5122
Country	:	US
Telephone Number	:	786-487-8331
Fax Number	:	786-487-8331

Provider Business Practice Location Address
First Line	:	1531 NW 173RD TER
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33169-5122
Country	:	US
Telephone Number	:	786-487-8331
Fax Number	:	786-487-8331

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DANIELLE GREENE
Credential	:
Telephone Number	:	786-487-8331

Provider Enumeration Date	:	05/16/2024
Last Update Date	:	05/16/2024

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