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General NPI Number Information
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NPI Number | 1730875923
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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 | 04/12/2023
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Last Update Date | 04/12/2023
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Provider Practice Location Address
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Address Line | 12 SE 7TH ST STE 705
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City | FORT LAUDERDALE
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State | FL
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Zip | 33301-3469
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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 N OCEAN BLVD APT 603
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City | FORT LAUDERDALE
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State | FL
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Zip | 33308-7188
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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 | MD
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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 | 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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