MEDICARE: SERENITY BEHAVIORAL HEALTH LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TA0400X	Addiction (Substance Use Disorder) Psychologist	ME99606	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023365624
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERENITY BEHAVIORAL HEALTH LLC

Provider Business Mailing Address
First Line	:	2303 HOLLYWOOD BLVD
Second Line	:	SUITE 12
City	:	HOLLYWOOD
State	:	FL
Zip	:	33020-6711
Country	:	US
Telephone Number	:	954-367-7944
Fax Number	:	954-374-8311

Provider Business Practice Location Address
First Line	:	2303 HOLLYWOOD BLVD
Second Line	:	SUITE 12
City	:	HOLLYWOOD
State	:	FL
Zip	:	33020-6711
Country	:	US
Telephone Number	:	954-367-7944
Fax Number	:	954-374-8311

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. SALVATORE PALERMO
Credential	:
Telephone Number	:	954-367-7944

Provider Enumeration Date	:	08/14/2012
Last Update Date	:	08/14/2012

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