MEDICARE: NORTHSTAR BEHAVIORAL HEALTH SERVICES, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	103TP2701X	Group Psychotherapy Psychologist
2	133N00000X	Nutritionist
3	133V00000X	Registered Dietitian
4	174400000X	Specialist
5	2083B0002X	Obesity Medicine (Preventive Medicine) Physician
6	2084P0804X	Child & Adolescent Psychiatry Physician
7	363LA2200X	Adult Health Nurse Practitioner
8	2084B0040X	Behavioral Neurology & Neuropsychiatry Physician

General Provider Information

NPI Number	:	1356287486
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHSTAR BEHAVIORAL HEALTH SERVICES, LLC

Provider Business Mailing Address
First Line	:	420 US HIGHWAY 1 STE 15
Second Line	:
City	:	NORTH PALM BEACH
State	:	FL
Zip	:	33408-5599
Country	:	US
Telephone Number	:	561-781-9400
Fax Number	:

Provider Business Practice Location Address
First Line	:	5220 HOOD RD STE 101
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33418-8910
Country	:	US
Telephone Number	:	561-781-9400
Fax Number	:

Authorized Official
Title or Position	:	COMPLIANCE EXECUTIVE ADMINISTRATOR
Name	:	JORDAN DE MARIE
Credential	:
Telephone Number	:	561-503-7933

Provider Enumeration Date	:	04/29/2026
Last Update Date	:	04/29/2026

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