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General NPI Number Information
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NPI Number | 1245836584
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Entity Type | Organization
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Legal Business Name | SOCRA HEALTH LLC
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Dates
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Enumeration Date | 12/10/2020
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Last Update Date | 11/09/2022
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Provider Practice Location Address
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Address Line | 409 S DIXIE HWY STE 6
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City | LAKE WORTH
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State | FL
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Zip | 33460-4405
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Country | US
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Telephone | 561-568-1584
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Fax |
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Provider Business Mailing Address
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Address Line | 2250 PALM BEACH LAKES BLVD STE 106C
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City | WEST PALM BEACH
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State | FL
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Zip | 33409-3407
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Country | US
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Telephone | 786-828-4884
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | RAIZA JIMENEZ
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Credential |
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Telephone | 786-828-4884
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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