Healthcare Provider Details

I. General information

NPI: 1184267858
Provider Name (Legal Business Name): COMFORT EBOB NJI-MBAH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2019
Last Update Date: 05/13/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4905 LANTANA RD
LAKE WORTH FL
33463-6915
US

IV. Provider business mailing address

6105 WALNUT HILL DR
LAKE WORTH FL
33467-6182
US

V. Phone/Fax

Practice location:
  • Phone: 561-340-7269
  • Fax:
Mailing address:
  • Phone: 561-909-5284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH24036
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: