Provider Demographics
NPI:1508115957
Name:RONI KOMIE
Entity Type:Organization
Organization Name:RONI KOMIE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:RONI
Authorized Official - Middle Name:S
Authorized Official - Last Name:KOMIE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:954-929-5797
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:954-929-5798
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:954-929-5798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-30
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW2806314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility