Individual provider Active NPI

Crystal Prestia, LCSW, CAP

  • Social Worker
  • Pembroke Pines, FL
National Provider Identifier
1962952226
Registry record updated Sep 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
SW20973 Issued in FL
Practice address
1000 N Hiatus Rd Ste 120
Pembroke Pines, FL 33026-3094
Phone
(954) 651-3565
Fax
(754) 263-5932
NPI assigned
Oct 11, 2016
Reactivated
Mar 19, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 5, 2023

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X ADC-009802-2015 FL
Addiction (Substance Use Disorder) Counselor 101YA0400X CAP.0009802 FL
Social Worker 104100000X ISW15523 FL
Social Worker 104100000X SW20973 FL Primary

Addresses

Primary practice location

1000 N Hiatus Rd Ste 120
Pembroke Pines, FL 33026-3094

Mailing address

1000 N Hiatus Rd Ste 120
Pembroke Pines, FL 33026-3094
Phone (954) 651-3565

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
ADC-009802-2015FLMDAddiction (Substance Use Disorder) Counselor
CAP.0009802FLMDAddiction (Substance Use Disorder) Counselor
ISW15523FLMDSocial Worker
SW20973FLMDSocial Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Change Happens, LLC Social Worker CurrentSince Feb 1, 2023 Accepting new patients

Locations

1000 N Hiatus Rd
Ste 120
Pembroke Pines, FL 33026
Phone (954) 651-3565

1931 NW 150th Ave
Ste 244
Pembroke Pines, FL 33028

Organizations & group practices 1

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": "1476144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693872000000",
    "number": "1962952226",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 N HIATUS RD STE 120",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "330263094",
            "telephone_number": "954-651-3565",
            "fax_number": "754-263-5932"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 N HIATUS RD STE 120",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "330263094",
            "telephone_number": "954-651-3565",
            "fax_number": "754-263-5932"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRESTIA",
        "first_name": "CRYSTAL",
        "name_prefix": "Mrs.",
        "credential": "LCSW, CAP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-10-11",
        "last_updated": "2023-09-05",
        "certification_date": "2023-03-28",
        "deactivation_date": "2019-08-15",
        "reactivation_date": "2021-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "FL",
            "license": "ADC-009802-2015",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "FL",
            "license": "CAP.0009802",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "FL",
            "license": "ISW15523",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "FL",
            "license": "SW20973",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pembroke Pines, FL

Sources for this page

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