Individual provider Active NPI

Gretchen Shimpeno Haddad, LMHC

  • Mental Health Counselor
  • Hollywood, FL
National Provider Identifier
1104476555
Registry record updated Sep 18, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
MH15309 Issued in FL
Practice address
3400 N 29TH Ave
Hollywood, FL 33020-1002
Phone
(954) 276-3400
Fax
(954) 965-6444
NPI assigned
Sep 18, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X MH15309 FL Primary

Addresses

Primary practice location

3400 N 29TH Ave
Hollywood, FL 33020-1002

Mailing address

3400 N 29TH Ave
Hollywood, FL 33020-1002
Phone (954) 276-3400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240321002250 FL Practitioner - Mental Health Counselor 3274970629 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
MH15309FLMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
South Broward Hospital District CurrentSince Jan 1, 2024 Accepting new patients
South Broward Hospital District CurrentSince Jan 1, 2024 Accepting new patients

Locations

5595 S University Dr
Davie, FL 33328
Phone (954) 276-3400

3700 Johnson St
Ste C
Hollywood, FL 33021
Phone (954) 265-1400

3400 N 29th Ave
Hollywood, FL 33020
Phone (954) 276-3400

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1568764800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568764800000",
    "number": "1104476555",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 N 29TH AVE",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "330201002",
            "telephone_number": "954-276-3400",
            "fax_number": "954-965-6444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 N 29TH AVE",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "330201002",
            "telephone_number": "954-276-3400",
            "fax_number": "954-965-6444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HADDAD",
        "first_name": "GRETCHEN",
        "middle_name": "SHIMPENO",
        "credential": "LMHC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-09-18",
        "last_updated": "2019-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH15309",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hollywood, FL

Sources for this page

Verify at the official NPI Registry.