Healthcare Provider Details

I. General information

NPI: 1609581008
Provider Name (Legal Business Name): AMERICAN INTEGRATIVE HEALTH SYSTEMS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2023
Last Update Date: 01/19/2023
Certification Date: 01/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 QUANTUM LAKES DR STE 203
BOYNTON BEACH FL
33426-8323
US

IV. Provider business mailing address

2500 QUANTUM LAKES DR STE 203
BOYNTON BEACH FL
33426-8323
US

V. Phone/Fax

Practice location:
  • Phone: 561-783-9980
  • Fax:
Mailing address:
  • Phone: 561-783-9980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name: LISA CICETTI
Title or Position: MANAGING MEMBER
Credential: PSYD
Phone: 561-783-9980