Provider Demographics
NPI:1912372863
Name:AMITIE, LLC
Entity Type:Organization
Organization Name:AMITIE, LLC
Other - Org Name:AMITIE, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:E
Authorized Official - Last Name:ASSINTHE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:305-310-3015
Mailing Address - Street 1:3131 NW 68TH CT
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-1232
Mailing Address - Country:US
Mailing Address - Phone:305-310-3015
Mailing Address - Fax:305-847-1432
Practice Address - Street 1:3131 NW 68TH CT
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-1232
Practice Address - Country:US
Practice Address - Phone:786-779-8898
Practice Address - Fax:305-847-1432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-03
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW131311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL108887200Medicaid
FL5485861OtherAETNA
FL022753900Medicaid
FL5632569OtherCIGNA