Provider Demographics
NPI:1780012187
Name:RECIPROCATE 1906 LLC
Entity Type:Organization
Organization Name:RECIPROCATE 1906 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:I
Authorized Official - Last Name:GOLLOPP
Authorized Official - Suffix:SR
Authorized Official - Credentials:MS
Authorized Official - Phone:786-916-3660
Mailing Address - Street 1:PO BOX 694881
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33269-1881
Mailing Address - Country:US
Mailing Address - Phone:786-916-3660
Mailing Address - Fax:786-916-3662
Practice Address - Street 1:18425 NW 2ND AVE STE 330
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33169-4534
Practice Address - Country:US
Practice Address - Phone:786-916-3660
Practice Address - Fax:786-916-3662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-22
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty