Individual provider Active NPI

Michelle Kayla Roisman, LCSW

  • Clinical Social Worker
  • Hollywood, FL
National Provider Identifier
1851811103
Registry record updated Feb 5, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
SW16909 Issued in FL
Practice address
2699 Stirling Road
Building C #403E
Hollywood, FL 33312
Phone
(954) 591-8441
NPI assigned
Jun 27, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 5, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 100653-1 NY
Clinical Social Worker 1041C0700X SW16909 FL Primary

Addresses

Primary practice location

2699 Stirling Road
Building C #403E
Hollywood, FL 33312

Mailing address

490 Stonemont Dr
Weston, FL 33326-3500
Phone (954) 205-0868

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)
Enrolled

State licenses

LicenseStateTypeSpecialty
100653-1NYMDSocial Worker

NPI Registry JSON

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

{
    "created_epoch": "1498521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580860800000",
    "number": "1851811103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "490 STONEMONT DR",
            "city": "WESTON",
            "state": "FL",
            "postal_code": "333263500",
            "telephone_number": "954-205-0868"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2699 STIRLING ROAD",
            "address_2": "BUILDING C #403E",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "33312",
            "telephone_number": "954-591-8441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROISMAN",
        "first_name": "MICHELLE",
        "middle_name": "KAYLA",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-27",
        "last_updated": "2020-02-05",
        "certification_date": "2020-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NY",
            "license": "100653-1",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW16909",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hollywood, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2020; 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.