| Serenity Space Therapy Llc | |
|
2699 Stirling Rd Ste C403a Fort Lauderdale FL 33312-6564 | |
| (954) 999-2320 | |
| Not Available |
| Full Name | Serenity Space Therapy Llc |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 2699 Stirling Rd Ste C403a, Fort Lauderdale, Florida |
| Authorized Official Name and Position | Alexandra Vaganova (OWNER) |
| Authorized Official Contact | 9549992320 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Serenity Space Therapy Llc 2699 Stirling Rd Ste C403a Fort Lauderdale FL 33312-6564 Ph: (954) 999-2320 | Serenity Space Therapy Llc 2699 Stirling Rd Ste C403a Fort Lauderdale FL 33312-6564 Ph: (954) 999-2320 |
| NPI Number | 1801484407 |
|---|---|
| Provider Enumeration Date | 01/08/2021 |
| Last Update Date | 01/08/2021 |
| Certification Date | 01/08/2021 |
| Medicare PECOS PAC ID | 0446609812 |
|---|---|
| Medicare Enrollment ID | O20231211001154 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801484407 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | (* (Not Available)) | Primary |
| Provider Name | Alexandra Vaganova |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1982290045 PECOS PAC ID: 1355790726 Enrollment ID: I20231211002567 |
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