=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760570451
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MENTAL HEALTH ASSOCIATION IN INDIAN RIVER COUNTY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/10/2006
-----------------------------------------------------
Last Update Date | 06/10/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 820 37TH PLACE
-----------------------------------------------------
City | VERO BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32960-6562
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-569-9788
-----------------------------------------------------
Fax | 772-569-2088
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 820 37TH PLACE
-----------------------------------------------------
City | VERO BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32960-6562
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-569-9788
-----------------------------------------------------
Fax | 772-569-2088
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | ROBERT J BRUGNOLI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 772-226-5388
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------