Provider Demographics
NPI:1346765740
Name:JOSAPHAT, SHARICKA
Entity Type:Individual
Prefix:
First Name:SHARICKA
Middle Name:
Last Name:JOSAPHAT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4350 NW 32ND CT
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33319-5719
Mailing Address - Country:US
Mailing Address - Phone:954-802-6266
Mailing Address - Fax:
Practice Address - Street 1:4350 NW 32ND CT
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33319-5719
Practice Address - Country:US
Practice Address - Phone:954-802-6266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-07
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-17-36765106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician