Provider Demographics
NPI:1427265925
Name:VINIKOOR, ILENE M (DCSW, LMFT)
Entity type:Individual
Prefix:MRS
First Name:ILENE
Middle Name:M
Last Name:VINIKOOR
Suffix:
Gender:F
Credentials:DCSW, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 SE 12TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-1902
Mailing Address - Country:US
Mailing Address - Phone:954-522-7335
Mailing Address - Fax:
Practice Address - Street 1:420 SE 12TH ST
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-1902
Practice Address - Country:US
Practice Address - Phone:954-522-7335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW1041041C0700X
FLMT67106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical