Provider Demographics
NPI:1720483233
Name:JILL K. BERSHAD, LMHC, CAP
Entity Type:Organization
Organization Name:JILL K. BERSHAD, LMHC, CAP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:K
Authorized Official - Last Name:BERSHAD
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:561-289-1129
Mailing Address - Street 1:7900 GLADES RD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-4167
Mailing Address - Country:US
Mailing Address - Phone:561-289-1129
Mailing Address - Fax:954-278-8507
Practice Address - Street 1:7900 GLADES RD
Practice Address - Street 2:SUITE 230
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-4167
Practice Address - Country:US
Practice Address - Phone:561-289-1129
Practice Address - Fax:954-278-8507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-27
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH6133101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty