MEDICARE: PATHWAYS BEHAVIORAL GROUP

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	251B00000X	Case Management Agency
2	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1245533942
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PATHWAYS BEHAVIORAL GROUP

Provider Business Mailing Address
First Line	:	2881 E OAKLAND PARK BLVD
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33306-1813
Country	:	US
Telephone Number	:	786-468-3296
Fax Number	:	954-315-1763

Provider Business Practice Location Address
First Line	:	2881 E OAKLAND PARK BLVD
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33306-1813
Country	:	US
Telephone Number	:	786-468-3296
Fax Number	:	954-315-1763

Authorized Official
Title or Position	:	DIRECTOR
Name	:	LORI B BRYANT
Credential	:
Telephone Number	:	786-468-3296

Provider Enumeration Date	:	12/18/2010
Last Update Date	:	02/08/2012

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