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General NPI Number Information
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NPI Number | 1568439685
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Entity Type | Organization
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Legal Business Name | LEGACY BEHAVIORAL HEALTH CENTER INC
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Dates
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Enumeration Date | 03/07/2006
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Last Update Date | 02/04/2020
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Provider Practice Location Address
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Address Line | 15818 SW WARFIELD BLVD
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City | INDIANTOWN
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State | FL
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Zip | 34956-3513
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Country | US
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Telephone | 772-597-0411
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Fax | 772-597-0412
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Provider Business Mailing Address
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Address Line | PO BOX 458
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City | INDIANTOWN
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State | FL
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Zip | 34956-0458
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Country | US
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Telephone | 772-597-0411
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Fax | 772-597-0412
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. ALICIA B. PAJARES
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Credential | LCSW
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Telephone | 561-722-7866
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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 | SW5271
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 6427
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License Number State | FL
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Taxonomy #3
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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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