MEDICARE: KIM MOWATT LCSW

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	SW16162	FL

General Provider Information

NPI Number	:	1932764487
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIM MOWATT LCSW

Provider Business Mailing Address
First Line	:	17330 SW 22ND ST
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33029-5545
Country	:	US
Telephone Number	:	954-270-7786
Fax Number	:

Provider Business Practice Location Address
First Line	:	1925 S PERIMETER RD
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-7122
Country	:	US
Telephone Number	:	954-270-7786
Fax Number	:

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

Provider Enumeration Date	:	05/09/2019
Last Update Date	:	05/09/2019

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