Basic Information
| Provider Information | |||||||||
| NPI: | 1841588654 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HEARTSPEAK LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1581 SW 55TH AVE | ||||||||
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| City: | PLANTATION | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333175322 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9542576616 | ||||||||
| FaxNumber: | 9547334483 | ||||||||
| Practice Location | |||||||||
| Address1: | 3511 W COMMERCIAL BLVD | ||||||||
| Address2: | SUITE 305 | ||||||||
| City: | FT LAUDERDALE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333093331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9547333394 | ||||||||
| FaxNumber: | 9547334483 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2011 | ||||||||
| LastUpdateDate: | 07/13/2011 | ||||||||
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| AuthorizedOfficialLastName: | MURRAY | ||||||||
| AuthorizedOfficialFirstName: | CHRISTINE | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 9542576616 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | SW 8225 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.