Healthcare Provider Details

I. General information

NPI: 1689172850
Provider Name (Legal Business Name): DOREEN E. CAHILL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2018
Last Update Date: 01/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 N FEDERAL HWY STE 210
BOCA RATON FL
33431-5195
US

IV. Provider business mailing address

5589 FAIRWAY PARK DR APT 101
BOYNTON BEACH FL
33437-1738
US

V. Phone/Fax

Practice location:
  • Phone: 561-676-0293
  • Fax:
Mailing address:
  • Phone: 561-676-0293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberSW11519
License Number StateFL

VIII. Authorized Official

Name: DOREEN ELIZABETH CAHILL
Title or Position: MANAGER
Credential: LCSW
Phone: 561-676-0293