Provider Demographics
NPI:1114187937
Name:FLORIDA INSTITUTE FOR RECOVERY AND SEX THERAPY
Entity Type:Organization
Organization Name:FLORIDA INSTITUTE FOR RECOVERY AND SEX THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:JAMIESON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:954-463-6563
Mailing Address - Street 1:PO BOX 70747
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33307-0747
Mailing Address - Country:US
Mailing Address - Phone:954-463-6563
Mailing Address - Fax:954-206-1444
Practice Address - Street 1:2424 WILTON DR
Practice Address - Street 2:
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33305-1251
Practice Address - Country:US
Practice Address - Phone:954-563-6563
Practice Address - Fax:954-206-1444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW15311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty