MEDICARE: LGW BEHAVIORAL HEALTH INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	SW6206	FL
2	103TA0400X	Addiction (Substance Use Disorder) Psychologist	ME52952	FL

General Provider Information

NPI Number	:	1285952366
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LGW BEHAVIORAL HEALTH INC

Provider Business Mailing Address
First Line	:	6278 N FEDERAL HWY
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-1916
Country	:	US
Telephone Number	:	954-587-7771
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 E HILLSBORO BLVD STE 200E
Second Line	:
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33441-4202
Country	:	US
Telephone Number	:	954-587-7771
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	TERESA TAURIELLO
Credential	:
Telephone Number	:	954-587-7771

Provider Enumeration Date	:	05/13/2010
Last Update Date	:	05/13/2010

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Directions to “LGW BEHAVIORAL HEALTH INC ” Practice Location

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