Healthcare Provider Details

I. General information

NPI: 1326501024
Provider Name (Legal Business Name): PANDA THERAPY CIRCLE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2019
Last Update Date: 04/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 E PALMETTO PARK RD STE 800
BOCA RATON FL
33432-4833
US

IV. Provider business mailing address

170 NE 2ND ST # 1255
BOCA RATON FL
33432-3931
US

V. Phone/Fax

Practice location:
  • Phone: 561-704-7903
  • Fax:
Mailing address:
  • Phone: 561-704-7903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. ALEXANDER KAY
Title or Position: DIRECTOR
Credential: LCSW
Phone: 561-704-7903