Provider Demographics
NPI:1528794807
Name:METAMORPHOSIS PSYCHCIERGE LLC
Entity type:Organization
Organization Name:METAMORPHOSIS PSYCHCIERGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JASMINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, APRN
Authorized Official - Phone:313-949-9467
Mailing Address - Street 1:4920 SHALIMAR LN APT 4109
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-7171
Mailing Address - Country:US
Mailing Address - Phone:313-949-9467
Mailing Address - Fax:
Practice Address - Street 1:401 E LAS OLAS BLVD STE 1400
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-2218
Practice Address - Country:US
Practice Address - Phone:313-949-9467
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-28
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health