MEDICARE: MENTAL HEALTH SERVICES OF DELRAY BEACH

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1710382213
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MENTAL HEALTH SERVICES OF DELRAY BEACH

Provider Business Mailing Address
First Line	:	223 NE 5TH AVE STE 103A
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33483-5530
Country	:	US
Telephone Number	:	561-270-2361
Fax Number	:	561-270-2081

Provider Business Practice Location Address
First Line	:	223 NE 5TH AVE STE 103A
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33483-5530
Country	:	US
Telephone Number	:	561-270-2361
Fax Number	:	561-270-2081

Authorized Official
Title or Position	:	DIRECTOR
Name	:	ANGELA IACULLO
Credential	:
Telephone Number	:	561-270-2361

Provider Enumeration Date	:	10/27/2014
Last Update Date	:	10/27/2014

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