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General NPI Number Information
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NPI Number | 1538462130
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Entity Type | Organization
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Legal Business Name | EAST FLORIDA BEHAVIORAL HEALTH NETWORK, LLC
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Dates
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Enumeration Date | 12/21/2010
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Last Update Date | 12/21/2010
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Provider Practice Location Address
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Address Line | 2201 45TH ST
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City | WEST PALM BEACH
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State | FL
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Zip | 33407-2047
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Country | US
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Telephone | 561-863-3824
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Fax |
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Provider Business Mailing Address
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Address Line | 111 JFK DR STE A
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City | ATLANTIS
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State | FL
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Zip | 33462-6634
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Country | US
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Telephone | 561-548-3716
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Fax |
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Authorized Official
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Title or Position | AVP OPERATIONS
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Name | ANGELA W BRADY
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Credential |
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Telephone | 843-813-6397
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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