| Dlj Clinical Services, Llc | |
|
10 Fairway Dr Ste 140v Deerfield Beach FL 33441-1812 | |
| (561) 921-7149 | |
| (561) 530-2039 |
| Full Name | Dlj Clinical Services, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 10 Fairway Dr Ste 140v, Deerfield Beach, Florida |
| Authorized Official Name and Position | Danyell Johnson (CEO) |
| Authorized Official Contact | 5619217149 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dlj Clinical Services, Llc 10 Fairway Dr Ste 140v Deerfield Beach FL 33441-1812 Ph: (561) 921-7149 | Dlj Clinical Services, Llc 10 Fairway Dr Ste 140v Deerfield Beach FL 33441-1812 Ph: (561) 921-7149 |
| NPI Number | 1457868812 |
|---|---|
| Provider Enumeration Date | 01/08/2018 |
| Last Update Date | 01/19/2023 |
| Certification Date | 01/19/2023 |
| Medicare PECOS PAC ID | 4183966518 |
|---|---|
| Medicare Enrollment ID | O20190503000924 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457868812 | NPI | - | NPPES |
| 1285981050 | Other | FL | INDIVIDUAL NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 104100000X | Social Worker | SW13061 (Florida) | Secondary |
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Danyell Johnson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1285981050 PECOS PAC ID: 5092057422 Enrollment ID: I20190503000959 |
| Provider Name | Tiarra Lois Steadman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1700458429 PECOS PAC ID: 3870970296 Enrollment ID: I20220524001271 |
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