MEDICARE: MIND-NEURO AND BEHAVIORAL CARE LLC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1376328195
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIND-NEURO AND BEHAVIORAL CARE LLC

Provider Business Mailing Address
First Line	:	6238 SAND HILLS CIR
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33463-8226
Country	:	US
Telephone Number	:	407-272-0201
Fax Number	:

Provider Business Practice Location Address
First Line	:	6238 SAND HILLS CIR
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33463-8226
Country	:	US
Telephone Number	:	407-272-0201
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ROLANDE J BELLEGARDE
Credential	:	APRN
Telephone Number	:	407-272-0201

Provider Enumeration Date	:	08/29/2023
Last Update Date	:	08/29/2023

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