Healthcare Provider Details

I. General information

NPI: 1194345090
Provider Name (Legal Business Name): MINDY MCGUIRE, PHD, LCSW, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2020
Last Update Date: 04/21/2020
Certification Date: 04/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 N FEDERAL HWY STE 206-11
BOCA RATON FL
33431-6049
US

IV. Provider business mailing address

6392 BELLAMALFI ST
BOCA RATON FL
33496-3277
US

V. Phone/Fax

Practice location:
  • Phone: 561-859-4568
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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. MINDY MCGUIRE
Title or Position: OWNER
Credential: PHD, LCSW
Phone: 561-859-4568