Healthcare Provider Details

I. General information

NPI: 1598469736
Provider Name (Legal Business Name): PSYCHIATRIC MENTAL HEALTH ASSOCIATES OF FLORIDA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2023
Last Update Date: 06/30/2023
Certification Date: 04/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1931 NW 150TH AVE STE 290
PEMBROKE PINES FL
33028-2886
US

IV. Provider business mailing address

1931 NW 150TH AVE STE 290
PEMBROKE PINES FL
33028-2886
US

V. Phone/Fax

Practice location:
  • Phone: 954-228-7856
  • Fax:
Mailing address:
  • Phone: 954-228-7856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. BOBBY VARGHESE
Title or Position: PRESIDENT
Credential: PHD, APRN, PMHNP-BC
Phone: 954-228-7856