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General NPI Number Information
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NPI Number | 1992133946
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Entity Type | Organization
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Legal Business Name | MINDFUL BEHAVIORAL HEALTH PLLC
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Dates
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Enumeration Date | 10/29/2013
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Last Update Date | 03/22/2017
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Provider Practice Location Address
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Address Line | 2201 NW CORPORATE BLVD SUITE 202
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City | BOCA RATON
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State | FL
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Zip | 33431-7337
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Country | US
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Telephone | 561-499-6933
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Fax | 561-235-5172
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Provider Business Mailing Address
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Address Line | 2201 NW CORPORATE BLVD SUITE 202
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City | BOCA RATON
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State | FL
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Zip | 33431-7337
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Country | US
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Telephone | 561-499-6933
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Fax | 561-235-5172
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. IVAN E CICHOWICZ
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Credential | M.D.
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Telephone | 561-499-6933
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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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