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General NPI Number Information
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NPI Number | 1992239917
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Entity Type | Organization
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Legal Business Name | DELRAY BEACH WELLNESS CENTER LLC
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Dates
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Enumeration Date | 04/17/2017
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Last Update Date | 04/17/2017
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Provider Practice Location Address
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Address Line | 1300 NW 17TH AVE SUITE 145
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City | DELRAY BEACH
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State | FL
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Zip | 33445-2578
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Country | US
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Telephone | 844-763-9968
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Fax | 877-281-1665
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Provider Business Mailing Address
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Address Line | 1300 NW 17TH AVE SUITE 145
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City | DELRAY BEACH
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State | FL
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Zip | 33445-2578
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Country | US
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Telephone | 844-763-9968
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Fax | 877-281-1665
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | VERONICA HERNANDEZ
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Credential |
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Telephone | 954-203-3584
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207RA0401X
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Taxonomy Name | Addiction Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number |
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License Number State |
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