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General NPI Number Information
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NPI Number | 1194144212
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Entity Type | Organization
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Legal Business Name | COMMUNITY PARTNERSHIP GROUYP
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Dates
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Enumeration Date | 04/16/2014
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Last Update Date | 04/16/2014
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Provider Practice Location Address
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Address Line | 2001 BLUE HERON BLVD W
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City | RIVIERA BEACH
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State | FL
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Zip | 33404-5003
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Country | US
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Telephone | 561-841-3500
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Fax |
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Provider Business Mailing Address
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Address Line | 305 LOCK RD APT 10
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City | DEERFIELD BEACH
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State | FL
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Zip | 33442-1565
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Country | US
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Telephone | 954-501-8824
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Fax |
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Authorized Official
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Title or Position | CHILD AND FAMILY THERAPIST
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Name | MICHEL PETIT-FRERE
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Credential | COUNSELOR
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Telephone | 954-501-8824
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 305R00000X
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License Number State | FL
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