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General NPI Number Information
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NPI Number | 1770746851
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Entity Type | Organization
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Legal Business Name | TRADELPHIS LLC
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Dates
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Enumeration Date | 07/08/2008
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Last Update Date | 07/08/2008
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Provider Practice Location Address
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Address Line | 600 N PINE ISLAND RD SUITE 450
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City | PLANTATION
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State | FL
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Zip | 33324-1393
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Country | US
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Telephone | 954-559-2936
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Fax |
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Provider Business Mailing Address
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Address Line | 7378 W ATLANTIC BLVD SUITE 388
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City | MARGATE
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State | FL
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Zip | 33063-4214
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Country | US
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Telephone | 954-559-2936
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | CHANTAL M GAGNON
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Credential | MS, MA, LMHC
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Telephone | 954-559-2936
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | MH9510
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License Number State | FL
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