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General NPI Number Information
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NPI Number | 1245341064
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Entity Type | Organization
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Legal Business Name | CENTER FOR DYNAMIC WELL BEING INC
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 02/22/2008
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Provider Practice Location Address
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Address Line | 7700 CONGRESS AVE 1131
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City | BOCA RATON
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State | FL
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Zip | 33487-1352
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Country | US
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Telephone | 561-826-1901
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Fax | 561-826-1902
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Provider Business Mailing Address
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Address Line | 7700 CONGRESS AVE 1131
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City | BOCA RATON
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State | FL
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Zip | 33487-1352
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Country | US
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Telephone | 561-826-1901
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Fax | 561-826-1902
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. LINDA BETH GAINES
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Credential | LCSW
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Telephone | 561-826-1901
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW7630
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License Number State | FL
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