Healthcare Provider Details

I. General information

NPI: 1992133946
Provider Name (Legal Business Name): MINDFUL BEHAVIORAL HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2013
Last Update Date: 03/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 NW CORPORATE BLVD SUITE 202
BOCA RATON FL
33431-7337
US

IV. Provider business mailing address

2201 NW CORPORATE BLVD SUITE 202
BOCA RATON FL
33431-7337
US

V. Phone/Fax

Practice location:
  • Phone: 561-499-6933
  • Fax: 561-235-5172
Mailing address:
  • Phone: 561-499-6933
  • Fax: 561-235-5172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. IVAN E CICHOWICZ
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 561-499-6933