Healthcare Provider Details

I. General information

NPI: 1891924924
Provider Name (Legal Business Name): KEY WEST BEHAVIORAL HEALTH INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2009
Last Update Date: 07/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 KENNEDY DR
KEY WEST FL
33040-4023
US

IV. Provider business mailing address

1200 KENNEDY DR
KEY WEST FL
33040-4023
US

V. Phone/Fax

Practice location:
  • Phone: 305-294-5592
  • Fax: 305-294-5594
Mailing address:
  • Phone: 305-294-5592
  • Fax: 305-294-5594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME100952
License Number StateFL

VIII. Authorized Official

Name: CARA M YERGEN
Title or Position: OWNER/MD
Credential: MD
Phone: 305-294-5592