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2000 N Florida Mango Rd Ste 107b West Palm Beach FL 33409 | |
| (561) 702-7482 | |
| (561) 828-7720 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 2000 N Florida Mango Rd Ste 107b, West Palm Beach, Florida |
| Authorized Official Name and Position | Mandi Duggan (OWNER) |
| Authorized Official Contact | 5617027482 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
825 Valley Forge Rd West Palm Beach FL 33405-3935 Ph: (561) 702-7482 | 2000 N Florida Mango Rd Ste 107b West Palm Beach FL 33409 Ph: (561) 702-7482 |
| NPI Number | 1902394273 |
|---|---|
| Provider Enumeration Date | 04/23/2018 |
| Last Update Date | 05/22/2018 |
| Medicare PECOS PAC ID | 8426490855 |
|---|---|
| Medicare Enrollment ID | O20240530001297 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902394273 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | MH8930 (Florida) | Primary |
| Provider Name | Mandi Renee Duggan |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1376718098 PECOS PAC ID: 9335581768 Enrollment ID: I20240530001558 |
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