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General NPI Number Information
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NPI Number | 1427726074
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Entity Type | Organization
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Legal Business Name | NEW WAVE MENTAL HEALTH, LLC
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Dates
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Enumeration Date | 08/31/2021
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Last Update Date | 08/31/2021
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Provider Practice Location Address
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Address Line | 1034 GATEWAY BLVD STE 1041034
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City | BOYNTON BEACH
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State | FL
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Zip | 33426-8369
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Country | US
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Telephone | 561-593-7114
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Fax |
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Provider Business Mailing Address
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Address Line | 1034 GATEWAY BLVD STE 104
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City | BOYNTON BEACH
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State | FL
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Zip | 33426-8360
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Country | US
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Telephone | 561-715-0548
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. LINDA K POTERE
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Credential | MBA
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Telephone | 954-695-6847
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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