Healthcare Provider Details

I. General information

NPI: 1427081603
Provider Name (Legal Business Name): NORTH STAR CENTRE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 01/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7860 GLADES RD SUITE 225
BOCA RATON FL
33434-4175
US

IV. Provider business mailing address

7860 GLADES RD SUITE 225
BOCA RATON FL
33434-4175
US

V. Phone/Fax

Practice location:
  • Phone: 561-361-0500
  • Fax: 561-479-0384
Mailing address:
  • Phone: 561-361-0500
  • Fax: 561-479-0384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: IRA S KAUFMAN
Title or Position: EXECUTIVE DIRECTOR
Credential: LCSW
Phone: 561-361-0500