MEDICARE: MS. CHERYL MARIE DESMIDT MS LMFT

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	MT2173	FL

General Provider Information

NPI Number	:	1770685760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHERYL MARIE DESMIDT MS LMFT

Provider Business Mailing Address
First Line	:	2699 STIRLING RD
Second Line	:	SUITE A105
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33312-6517
Country	:	US
Telephone Number	:	954-989-8818
Fax Number	:	954-989-8812

Provider Business Practice Location Address
First Line	:	2699 STIRLING RD
Second Line	:	SUITE A105
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33312-6517
Country	:	US
Telephone Number	:	954-989-8818
Fax Number	:	954-989-8812

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

Provider Enumeration Date	:	09/01/2006
Last Update Date	:	02/26/2008

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