Healthcare Provider Details

I. General information

NPI: 1104068352
Provider Name (Legal Business Name): ELIZABETH H. FAULK FOUNDATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2009
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22455 BOCA RIO RD
BOCA RATON FL
33433-4708
US

IV. Provider business mailing address

22455 BOCA RIO RD
BOCA RATON FL
33433-4708
US

V. Phone/Fax

Practice location:
  • Phone: 561-483-5300
  • Fax: 561-483-5325
Mailing address:
  • Phone: 561-483-5300
  • Fax: 561-483-5325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. HOLLY KATZ
Title or Position: CLINICAL AND TRAINING DIRECTOR
Credential: PH.D.
Phone: 561-483-5300