Provider Demographics
NPI:1710223458
Name:EMPOWER ME CLINICAL PRACTICE, LLC
Entity Type:Organization
Organization Name:EMPOWER ME CLINICAL PRACTICE, LLC
Other - Org Name:DR. SELENA LAMOTTE, DSW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SELENA
Authorized Official - Middle Name:A
Authorized Official - Last Name:LAMOTTE
Authorized Official - Suffix:
Authorized Official - Credentials:DSW, LCSW, C-ACYFSW
Authorized Official - Phone:561-469-9670
Mailing Address - Street 1:10568 LONGLEAF LN
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-9398
Mailing Address - Country:US
Mailing Address - Phone:561-469-9670
Mailing Address - Fax:561-634-3861
Practice Address - Street 1:10568 LONGLEAF LN
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414
Practice Address - Country:US
Practice Address - Phone:561-469-9670
Practice Address - Fax:561-634-3861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-28
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW110991041C0700X, 1041C0700X
101YP2500X, 1041C0700X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL007968500Medicaid