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General NPI Number Information
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NPI Number | 1639865678
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Entity Type | Organization
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Legal Business Name | PRIVATE MENTAL HEALTH GROUP LLC
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Dates
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Enumeration Date | 04/13/2023
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Last Update Date | 04/13/2023
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Provider Practice Location Address
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Address Line | 12 SE 7TH STREET SUITE 705
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City | FORT LAUDERDALE
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State | FL
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Zip | 33301
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Country | US
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Telephone | 954-794-9000
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Fax | 754-800-2610
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Provider Business Mailing Address
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Address Line | 3100 NORTH OCEAN BLVD UNIT 603
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City | FORT LAUDERDALE
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State | FL
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Zip | 33308
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Country | US
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Telephone | 646-512-3203
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Fax | 754-800-2610
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. OLGA KATZ
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Credential | M.D.
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Telephone | 917-494-4975
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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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 | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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