Provider Demographics
NPI:1639796675
Name:SEASONS PSYCHOTHERAPY ASSOCIATES LLC
Entity Type:Organization
Organization Name:SEASONS PSYCHOTHERAPY ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-342-0982
Mailing Address - Street 1:2601 E OAKLAND PARK BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33306-1658
Mailing Address - Country:US
Mailing Address - Phone:954-342-0982
Mailing Address - Fax:954-342-1080
Practice Address - Street 1:12505 ORANGE DR STE 901
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33330-4300
Practice Address - Country:US
Practice Address - Phone:954-342-0982
Practice Address - Fax:954-342-1080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-25
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL108602800Medicaid