Individual provider Active NPI

Sarah Roque, LMHC, LPC, MCAP

  • Clinical Social Worker
  • Fort Lauderdale, FL
National Provider Identifier
1124660352
Registry record updated Jul 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
MH16243 Issued in FL
Practice address
846 SW 14TH St
Fort Lauderdale, FL 33315
Phone
(407) 308-2871
NPI assigned
Oct 9, 2019
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 6, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X MH16243 FL Primary
Mental Health CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YM0800X MH16243 FL

Addresses

Primary practice location

846 SW 14TH St
Fort Lauderdale, FL 33315

Mailing address

4655 Osage Beach Pkwy Ste a #241
Osage Beach, MO 65065
Phone (407) 308-2871

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
MH16243FLMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Making Changes Counseling LLC Mental Health CurrentSince Jul 9, 2023 Accepting new patients
Henderson Behavioral Health, Inc. PastSince Mar 1, 2020 Accepting new patients
Henderson Behavioral Health, Inc. Single Specialty PastSince Mar 1, 2020 Accepting new patients

Locations

4655 Osage Beach Pkwy
Ste A
Osage Beach, MO 65065
Phone (407) 308-2871

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": "1570579200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688601600000",
    "number": "1124660352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4655 OSAGE BEACH PKWY STE A #241",
            "city": "OSAGE BEACH",
            "state": "MO",
            "postal_code": "65065",
            "telephone_number": "407-308-2871"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "846 SW 14TH ST",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "33315",
            "telephone_number": "407-308-2871"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROQUE",
        "first_name": "SARAH",
        "credential": "LMHC, LPC, MCAP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-10-09",
        "last_updated": "2023-07-06",
        "certification_date": "2023-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "MH16243",
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH16243",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Lauderdale, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.