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NPI Code Detail

MEDICARE: INFINITE BEHAVIORAL HEALTH

MEDICARE: INFINITE BEHAVIORAL HEALTH
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
1103TC0700XClinical PsychologistPY7670FL

General Provider Information

NPI Number : 1649588757
Entity Type Code : Organization
Provider Name (Legal Business Name) : INFINITE BEHAVIORAL HEALTH
Provider Business Mailing Address
First Line : 2421 HOLLYWOOD BLVD
Second Line : SUITE 1 AND 2
City : HOLLYWOOD
State : FL
Zip : 33020-6605
Country : US
Telephone Number : 954-923-9111
Fax Number : 954-923-9190
Provider Business Practice Location Address
First Line : 2303 HOLLYWOOD BLVD
Second Line : SUITE 1 AND 2
City : HOLLYWOOD
State : FL
Zip : 33020-6711
Country : US
Telephone Number : 954-309-5667
Fax Number : 305-935-3172
Authorized Official
Title or Position : CLINICAL DIRECTOR
Name : MS. JULIE DARA BRUNO
Credential : PSY.D
Telephone Number : 954-881-1129
Provider Enumeration Date : 09/23/2010
Last Update Date : 03/04/2013

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Directions to “INFINITE BEHAVIORAL HEALTH ” Practice Location

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