Basic Information
| Provider Information | |||||||||
| NPI: | 1720316557 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ADDICTION SPECIALISTS OF MARGATE INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5110 COCONUT CREEK PKWY | ||||||||
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| City: | MARGATE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330633913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9545877771 | ||||||||
| FaxNumber: | 9542524176 | ||||||||
| Practice Location | |||||||||
| Address1: | 5110 COCONUT CREEK PKWY | ||||||||
| Address2: | |||||||||
| City: | MARGATE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330633913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9545877771 | ||||||||
| FaxNumber: | 9542524176 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/07/2009 | ||||||||
| LastUpdateDate: | 12/07/2009 | ||||||||
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| AuthorizedOfficialLastName: | REDLICH | ||||||||
| AuthorizedOfficialFirstName: | BEA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9545877771 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TP2701X | ME87029 | FL | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Group Psychotherapy |
No ID Information.