MEDICARE: ADDICTION SPECIALISTS OF MARGATE 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	103TP2701X	Group Psychotherapy Psychologist	ME87029	FL

General Provider Information

NPI Number	:	1720316557
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADDICTION SPECIALISTS OF MARGATE INC

Provider Business Mailing Address
First Line	:	5110 COCONUT CREEK PKWY
Second Line	:
City	:	MARGATE
State	:	FL
Zip	:	33063-3913
Country	:	US
Telephone Number	:	954-587-7771
Fax Number	:	954-252-4176

Provider Business Practice Location Address
First Line	:	5110 COCONUT CREEK PKWY
Second Line	:
City	:	MARGATE
State	:	FL
Zip	:	33063-3913
Country	:	US
Telephone Number	:	954-587-7771
Fax Number	:	954-252-4176

Authorized Official
Title or Position	:	CEO
Name	:	MRS. BEA REDLICH
Credential	:
Telephone Number	:	954-587-7771

Provider Enumeration Date	:	12/07/2009
Last Update Date	:	12/07/2009

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