MEDICARE: MENTAL HEALTH ASSOCIATION OF PALM BEACH COUNTY, INC.

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	251V00000X	Voluntary or Charitable Agency

General Provider Information

NPI Number	:	1205175130
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MENTAL HEALTH ASSOCIATION OF PALM BEACH COUNTY, INC.

Provider Business Mailing Address
First Line	:	909 FERN ST
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33401-5717
Country	:	US
Telephone Number	:	561-832-3755
Fax Number	:	561-832-3900

Provider Business Practice Location Address
First Line	:	909 FERN ST
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33401-5717
Country	:	US
Telephone Number	:	561-832-3755
Fax Number	:	561-832-3900

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MS. PAMELA GIONFRIDDO
Credential	:
Telephone Number	:	561-832-3755

Provider Enumeration Date	:	02/13/2013
Last Update Date	:	02/13/2013

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