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General NPI Number Information
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NPI Number | 1205259975
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Entity Type | Organization
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Legal Business Name | NEW DIRECTIONS 2.0 LLC
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Dates
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Enumeration Date | 01/30/2014
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Last Update Date | 01/30/2014
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Provider Practice Location Address
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Address Line | 2290 10TH AVE NORTH STE 201
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City | LAKE WORTH
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State | FL
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Zip | 33461
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Country | US
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Telephone | 561-734-6118
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Fax |
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Provider Business Mailing Address
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Address Line | 2290 10TH AVE NORTH STE 201
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City | LAKE WORTH
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State | FL
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Zip | 33461
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Country | US
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Telephone | 561-734-6118
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. LISA CICETTI
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Credential | PSYD., LMHC
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Telephone | 561-734-6118
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | PY7715
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License Number State | FL
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