| NPI | 1134373566 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SCOTT MICHAEL COSTANZA Clinical Director 561-279-9295 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: FL PY5739) |
| 103TC0700X Psychologist, Clinical (Licence: FL PY5739) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: FL PY5739) | |
| 103TF0200X Psychologist, Forensic (Licence: FL PY5739) | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: FL PY5739) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: FL PY5739) | |
| 106H00000X Marriage & Family Therapist (Licence: FL PY5739) | |
| Enumeration Date | 2008-11-12 |
| Last Update Date | 2020-06-05 |