| Center For Identity Development South Ltd Inc | |
|
4855 W Hillsboro Blvd Suite B1 Coconut Creek FL 33073-4356 | |
| (954) 345-5525 | |
| (954) 977-4978 |
| Full Name | Center For Identity Development South Ltd Inc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 4855 W Hillsboro Blvd, Coconut Creek, Florida |
| Authorized Official Name and Position | Michele Linda Lanese (PRESIDENT CENTER FOR IDENTITY DEVEL) |
| Authorized Official Contact | 9543455525 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Center For Identity Development South Ltd Inc 4855 W Hillsboro Blvd Suite B1 Coconut Creek FL 33073-4356 Ph: (954) 345-5525 | Center For Identity Development South Ltd Inc 4855 W Hillsboro Blvd Suite B1 Coconut Creek FL 33073-4356 Ph: (954) 345-5525 |
| NPI Number | 1295894301 |
|---|---|
| Provider Enumeration Date | 12/06/2006 |
| Last Update Date | 07/29/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295894301 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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