Provider Demographics
NPI:1699264184
Name:ROISMAN, MICHAEL (MSW, CAP, ICADC, SAP)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:ROISMAN
Suffix:
Gender:M
Credentials:MSW, CAP, ICADC, SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10041 SW 144TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-7083
Mailing Address - Country:US
Mailing Address - Phone:305-926-8510
Mailing Address - Fax:
Practice Address - Street 1:7520 SW 57TH AVE STE D
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-5330
Practice Address - Country:US
Practice Address - Phone:305-710-5288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-09
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLADC-009399-2015101YA0400X
FL804596101YA0400X
FL16360816101YA0400X
FLSW175811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)