Provider Demographics
NPI:1851811103
Name:ROISMAN, MICHELLE KAYLA (LCSW)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:KAYLA
Last Name:ROISMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:490 STONEMONT DR
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-3500
Mailing Address - Country:US
Mailing Address - Phone:954-205-0868
Mailing Address - Fax:
Practice Address - Street 1:2699 STIRLING ROAD
Practice Address - Street 2:BUILDING C #403E
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33312
Practice Address - Country:US
Practice Address - Phone:954-591-8441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-27
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY100653-1104100000X
FLSW169091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker