1205175130 NPI number — MENTAL HEALTH ASSOCIATION OF PALM BEACH COUNTY, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205175130 NPI number — MENTAL HEALTH ASSOCIATION OF PALM BEACH COUNTY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MENTAL HEALTH ASSOCIATION OF PALM BEACH COUNTY, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205175130
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/13/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
909 FERN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST PALM BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33401-5717
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-832-3755
Provider Business Mailing Address Fax Number:
561-832-3900

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
909 FERN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST PALM BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33401-5717
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-832-3755
Provider Business Practice Location Address Fax Number:
561-832-3900
Provider Enumeration Date:
02/13/2013

Additional Information

Authorized Official

Authorized Official Last Name:
GIONFRIDDO
Authorized Official First Name:
PAMELA
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
561-832-3755

Provider Taxonomy Codes

  • Taxonomy code: 251V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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