Basic Information
| Provider Information | |||||||||
| NPI: | 1154943629 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOCIAL SCIENCE AND RESEARCH CONSULTANTS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 814358 | ||||||||
| Address2: | |||||||||
| City: | HOLLYWOOD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330814358 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7862467121 | ||||||||
| FaxNumber: | 7074433204 | ||||||||
| Practice Location | |||||||||
| Address1: | 3856 SW 52ND AVE | ||||||||
| Address2: | |||||||||
| City: | HOLLYWOOD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330236905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7862467121 | ||||||||
| FaxNumber: | 7074433204 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/07/2020 | ||||||||
| LastUpdateDate: | 05/07/2020 | ||||||||
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| AuthorizedOfficialLastName: | SAMUELS | ||||||||
| AuthorizedOfficialFirstName: | DEANNE | ||||||||
| AuthorizedOfficialMiddleName: | MICHELE | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7862467121 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | PHD | ||||||||
| NPICertificationDate: | 05/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0850X | N | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | 103T00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.