MEDICARE: KARISHA THOMAS MSW

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	101YM0800X	Mental Health Counselor		FL

General Provider Information

NPI Number	:	1881360329
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARISHA THOMAS MSW

Provider Business Mailing Address
First Line	:	4846 N UNIVERSITY DR STE 643
Second Line	:
City	:	LAUDERHILL
State	:	FL
Zip	:	33351-4510
Country	:	US
Telephone Number	:	954-471-7345
Fax Number	:

Provider Business Practice Location Address
First Line	:	4846 N UNIVERSITY DR STE 643
Second Line	:
City	:	LAUDERHILL
State	:	FL
Zip	:	33351-4510
Country	:	US
Telephone Number	:	954-471-7345
Fax Number	:

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

Provider Enumeration Date	:	08/16/2021
Last Update Date	:	08/16/2021

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