MEDICARE: IMARA COMMUNITY SERVICES

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	RN9206737	FL
2	101YM0800X	Mental Health Counselor	RN1525422	FL
3	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1396910071
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IMARA COMMUNITY SERVICES

Provider Business Mailing Address
First Line	:	2240 PALM BEACH LAKES BLVD
Second Line	:	SUITE 400E
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-3410
Country	:	US
Telephone Number	:	561-688-0870
Fax Number	:	561-537-7161

Provider Business Practice Location Address
First Line	:	2240 PALM BEACH LAKES BLVD
Second Line	:	SUITE 400E
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-3410
Country	:	US
Telephone Number	:	561-688-0870
Fax Number	:	561-537-7161

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	MRS. SHIRLEY ROBERTSON
Credential	:	R.N.
Telephone Number	:	561-688-0870

Provider Enumeration Date	:	04/24/2008
Last Update Date	:	08/20/2008

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Directions to “IMARA COMMUNITY SERVICES ” Practice Location

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