Provider Demographics
NPI:1992043657
Name:CINDY JILL NORTH LCSW., P.A.
Entity Type:Organization
Organization Name:CINDY JILL NORTH LCSW., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:JILL
Authorized Official - Last Name:NORTH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:954-322-1005
Mailing Address - Street 1:1931 NW 150TH AVE STE 124
Mailing Address - Street 2:PEMBROKE PINES
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-2873
Mailing Address - Country:US
Mailing Address - Phone:954-322-1005
Mailing Address - Fax:
Practice Address - Street 1:1931 NW 150TH AVE STE 124
Practice Address - Street 2:PEMBROKE PINES
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-2873
Practice Address - Country:US
Practice Address - Phone:954-322-1005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-30
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW39701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001524800Medicaid
FLZ6847AMedicare UPIN