MEDICARE: SOUTHWEST FLORIDA ASSOCIATES IN MENTAL HEALTH AND ADDICTIONS, P.A.

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	251S00000X	Community/Behavioral Health Agency	PY0003960	FL

General Provider Information

NPI Number	:	1689903650
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHWEST FLORIDA ASSOCIATES IN MENTAL HEALTH AND ADDICTIONS, P.A.

Provider Business Mailing Address
First Line	:	12657 NEW BRITTANY BLVD
Second Line	:	SUITE 12
City	:	FORT MEYERS
State	:	FL
Zip	:	33907-3631
Country	:	US
Telephone Number	:	239-940-1804
Fax Number	:	239-275-3964

Provider Business Practice Location Address
First Line	:	12657 NEW BRITTANY BLVD
Second Line	:	SUITE 12
City	:	FORT MEYERS
State	:	FL
Zip	:	33907-3631
Country	:	US
Telephone Number	:	239-940-1804
Fax Number	:	239-275-3964

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. NICHOLAS CHARLES ANTHONY
Credential	:	PHD
Telephone Number	:	239-940-1804

Provider Enumeration Date	:	12/21/2009
Last Update Date	:	12/21/2009

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