MEDICARE: SERENITY NOW CMHC, 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	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center	1550AD690501	FL

General Provider Information

NPI Number	:	1629098058
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERENITY NOW CMHC, INC.

Provider Business Mailing Address
First Line	:	2724 N AUSTRALIAN AVE
Second Line	:	BLDG. #1
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-4501
Country	:	US
Telephone Number	:	561-802-4211
Fax Number	:	561-802-4311

Provider Business Practice Location Address
First Line	:	2724 N AUSTRALIAN AVE
Second Line	:	BLDG. #1
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-4501
Country	:	US
Telephone Number	:	561-802-4211
Fax Number	:	561-802-4311

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARIA DICKEY
Credential	:	LMHC
Telephone Number	:	561-381-7707

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	01/05/2012

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