Healthcare Provider Details

I. General information

NPI: 1780493569
Provider Name (Legal Business Name): AWARE RECOVERY CLINICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2025
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 S PINE ISLAND RD
PLANTATION FL
33324-4413
US

IV. Provider business mailing address

35 THORPE AVE STE 104
WALLINGFORD CT
06492-1948
US

V. Phone/Fax

Practice location:
  • Phone: 203-490-4266
  • Fax:
Mailing address:
  • Phone: 203-490-4266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DANIELLE SMITH
Title or Position: REVENUE CYCLE MANAGER
Credential:
Phone: 203-671-0339