Provider Demographics
NPI:1326419573
Name:KOMIE, RONI (LCSW)
Entity Type:Individual
Prefix:
First Name:RONI
Middle Name:
Last Name:KOMIE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2751 S OCEAN DR
Mailing Address - Street 2:#1803-S
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33019-2721
Mailing Address - Country:US
Mailing Address - Phone:954-929-5797
Mailing Address - Fax:
Practice Address - Street 1:2751 S OCEAN DR
Practice Address - Street 2:#1803-S
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33019-2721
Practice Address - Country:US
Practice Address - Phone:954-929-5797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-14
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW28061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical