Provider Demographics
NPI:1659646453
Name:CAROLE FLASTER LCSW PA
Entity Type:Organization
Organization Name:CAROLE FLASTER LCSW PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLE
Authorized Official - Middle Name:
Authorized Official - Last Name:FLASTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-370-3335
Mailing Address - Street 1:5400 S UNIVERSITY DRIVE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-5309
Mailing Address - Country:US
Mailing Address - Phone:954-370-3335
Mailing Address - Fax:954-370-3353
Practice Address - Street 1:5400 S UNIVERSITY DRIVE
Practice Address - Street 2:SUITE 207
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-5309
Practice Address - Country:US
Practice Address - Phone:954-370-3335
Practice Address - Fax:954-370-3353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-13
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW8501041C0700X
FLMT415106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000900000Medicaid
FL217790OtherAVMED
FL029638OtherVALULE OPTIONS
FLZ-1041OtherBLUE CROSS BLUE SHIELD
FLZ-1041Medicare PIN