Healthcare Provider Details

I. General information

NPI: 1407783046
Provider Name (Legal Business Name): ERIC MALZ PMHNP-BC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2683 IRMA LAKE DR
WEST PALM BEACH FL
33411-5735
US

IV. Provider business mailing address

2683 IRMA LAKE DR
WEST PALM BEACH FL
33411-5735
US

V. Phone/Fax

Practice location:
  • Phone: 551-804-1618
  • Fax: 551-804-1618
Mailing address:
  • Phone: 551-804-1618
  • Fax: 551-804-1618

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

VIII. Authorized Official

Name: MR. ERIC MALZ ERIC MALZ
Title or Position: OWNER/PROVIDER
Credential: ERIC MALZ
Phone: 551-804-1618