MEDICARE: SYLVIA BRAFMAN MENTAL HEALTH CENTER LLC

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	261QM0850X	Adult Mental Health Clinic/Center
2	323P00000X	Psychiatric Residential Treatment Facility

General Provider Information

NPI Number	:	1982174066
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SYLVIA BRAFMAN MENTAL HEALTH CENTER LLC

Provider Business Mailing Address
First Line	:	6555 NW 9TH AVE STE 112
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33309-2048
Country	:	US
Telephone Number	:	954-771-2091
Fax Number	:

Provider Business Practice Location Address
First Line	:	6555 NW 9TH AVE STE 112
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33309-2048
Country	:	US
Telephone Number	:	954-771-2091
Fax Number	:	954-771-2098

Authorized Official
Title or Position	:	CFO
Name	:	CYNTHIA WISDOM
Credential	:
Telephone Number	:	954-771-2091

Provider Enumeration Date	:	11/30/2018
Last Update Date	:	12/03/2018

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