Serenity Counseling Services PA

Primary specialty

Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X

License

1943AD620400 Issued in FL

Legal business name

SERENITY COUNSELING SERVICES PA

Practice address

500 NW Dixie Hwy
Suite 102
Stuart, FL 34994

Phone

(772) 692-8585

Fax

(772) 692-5651

NPI assigned

Jan 26, 2007

Last updated

Oct 23, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Gilda G Broadwell, PHDNPI 1942421995

Title

Psychologist

Phone

(772) 692-8585

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Gilda G Broadwell, PHD

  • Psychologist
  • Stuart, FL
  • NPI 1942421995
  Medicare reassignment NPD Authorized official
• Nancy Ann Coppola, LCSW, CAP

  • Clinical Social Worker
  • Fort Pierce, FL
  • NPI 1760517668
  NPD (past)
• Nancy E King, LCSW

  • Clinical Social Worker
  • Jensen Beach, FL
  • NPI 1871700351
  NPD (past)

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

{
    "created_epoch": "1169769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1350950400000",
    "number": "1275689812",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2474",
            "city": "STUART",
            "state": "FL",
            "postal_code": "34995",
            "telephone_number": "772-692-8585",
            "fax_number": "772-692-5651"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 NW DIXIE HWY",
            "address_2": "SUITE 102",
            "city": "STUART",
            "state": "FL",
            "postal_code": "34994",
            "telephone_number": "772-692-8585",
            "fax_number": "772-692-5651"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SERENITY COUNSELING SERVICES PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-26",
        "last_updated": "2012-10-23",
        "status": "A",
        "authorized_official_last_name": "BROADWELL",
        "authorized_official_first_name": "GILDA",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "PSYCHOLOGIST",
        "authorized_official_telephone_number": "772-692-8585",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": "FL",
            "license": "PY5591",
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "FL",
            "license": "1943AD620400",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "C&F SUB ABUSE COUNSELING",
            "identifier": "15-43-AD-6204-00",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Melba Sequeira
• Mallory Serapin
• John Thomas Serbes McCain
• Sereen Care Inc
• Serendipity Therapeutic Massage and Bodywork, Inc.
• Serenity Family Wellness LTD
• Joao Miguel Serigado Soares Da Costa, M.D.
• Jose E Serra, MD
• Federico Jose Serrot, MD
• Lisa Sestan

• Substance Use Disorder Rehabilitation Clinic/Center in Stuart, FL
• Providers in Stuart, FL by specialty
• Substance Use Disorder Rehabilitation Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.