Provider Demographics
NPI:1578002234
Name:MOMPOINT, GUY-CLAUDE (NCSP)
Entity Type:Individual
Prefix:
First Name:GUY-CLAUDE
Middle Name:
Last Name:MOMPOINT
Suffix:
Gender:M
Credentials:NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2345 NW 14TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33311-5141
Mailing Address - Country:US
Mailing Address - Phone:305-951-3512
Mailing Address - Fax:
Practice Address - Street 1:15192 SW 137TH ST STE 13
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-5786
Practice Address - Country:US
Practice Address - Phone:786-255-3752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-14
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSS1410103TS0200X
247200000X, 247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Single Specialty
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020345800Medicaid