Provider Demographics
NPI:1841017225
Name:CHANGING TIDES THERAPY
Entity type:Organization
Organization Name:CHANGING TIDES THERAPY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:PIDERMANN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:954-710-7619
Mailing Address - Street 1:4301 S FLAMINGO RD STE 106
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33330-1902
Mailing Address - Country:US
Mailing Address - Phone:954-710-7619
Mailing Address - Fax:
Practice Address - Street 1:19410 SW 58TH PL
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33332-1301
Practice Address - Country:US
Practice Address - Phone:954-710-7619
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHANGING TIDES THERAPY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-09-25
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty