Basic Information
Provider Information | |||||||||
NPI: | 1750506333 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | COVE COUNSELING GROUP | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 5460 N STATE ROAD 7 | ||||||||
Address2: | SUITE 114 | ||||||||
City: | FT LAUDERDALE | ||||||||
State: | FL | ||||||||
PostalCode: | 333192952 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9545877771 | ||||||||
FaxNumber: | 9545878622 | ||||||||
Practice Location | |||||||||
Address1: | 5460 N STATE ROAD 7 | ||||||||
Address2: | SUITE 114 | ||||||||
City: | FT LAUDERDALE | ||||||||
State: | FL | ||||||||
PostalCode: | 333192952 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9545877771 | ||||||||
FaxNumber: | 9545878622 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/17/2007 | ||||||||
LastUpdateDate: | 08/22/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | FLAHERTY | ||||||||
AuthorizedOfficialFirstName: | DAVID | ||||||||
AuthorizedOfficialMiddleName: | HOWARD | ||||||||
AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
AuthorizedOfficialTelephone: | 9545877771 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | DR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | MD | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 283X00000X | 1006AD762001 | FL | Y |   | Hospitals | Rehabilitation Hospital |   |
No ID Information.