MEDICARE: MODERN REALITY

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	261QM0855X	Adolescent and Children Mental Health Clinic/Center

General Provider Information

NPI Number	:	1528628856
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MODERN REALITY

Provider Business Mailing Address
First Line	:	200 KNUTH RD STE 101
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33436-4635
Country	:	US
Telephone Number	:	561-402-9655
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 KNUTH RD STE 101
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33436-4635
Country	:	US
Telephone Number	:	561-402-9655
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CASEY BRANNIGAN
Credential	:
Telephone Number	:	561-402-9655

Provider Enumeration Date	:	06/18/2019
Last Update Date	:	06/18/2019

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Directions to “MODERN REALITY ” Practice Location

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