Provider Demographics
NPI:1578290599
Name:NOVA SOUHTEASTERN UNIVERSITY, INC
Entity Type:Organization
Organization Name:NOVA SOUHTEASTERN UNIVERSITY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CONTRACTING
Authorized Official - Prefix:
Authorized Official - First Name:ROSEMERY
Authorized Official - Middle Name:
Authorized Official - Last Name:ESTEVEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-262-4343
Mailing Address - Street 1:PO BOX 290370
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33329-0370
Mailing Address - Country:US
Mailing Address - Phone:954-262-4343
Mailing Address - Fax:
Practice Address - Street 1:3200 S UNIVERSITY DRIVE
Practice Address - Street 2:SANDFORD L ZIFF BUILDING 1ST FLOOR SUITE 4189
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33328-3332
Practice Address - Country:US
Practice Address - Phone:954-262-4113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NOVA SOUHTEASTERN UNIVERSITY, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-08-02
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamilyGroup - Multi-Specialty
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty