Healthcare Provider Details

I. General information

NPI: 1396366324
Provider Name (Legal Business Name): ALERE EMOTIONAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2020
Last Update Date: 04/30/2020
Certification Date: 04/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1016 CLARE AVE STE 5
WEST PALM BEACH FL
33401-6219
US

IV. Provider business mailing address

111 SE 1ST AVE APT 410
DELRAY BEACH FL
33444-3796
US

V. Phone/Fax

Practice location:
  • Phone: 561-703-2660
  • Fax:
Mailing address:
  • Phone: 561-703-2660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. ANTHONY ERIC GONZALEZ
Title or Position: OWNER
Credential: LCSW
Phone: 561-703-2660