Healthcare Provider Details

I. General information

NPI: 1285952366
Provider Name (Legal Business Name): LGW BEHAVIORAL HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2010
Last Update Date: 05/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 E HILLSBORO BLVD STE 200E
DEERFIELD BEACH FL
33441-4202
US

IV. Provider business mailing address

6278 N FEDERAL HWY
FORT LAUDERDALE FL
33308-1916
US

V. Phone/Fax

Practice location:
  • Phone: 954-587-7771
  • Fax:
Mailing address:
  • Phone: 954-587-7771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW6206
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License NumberME52952
License Number StateFL

VIII. Authorized Official

Name: TERESA TAURIELLO
Title or Position: OFFICE MANAGER
Credential:
Phone: 954-587-7771