Provider Demographics
NPI:1285074716
Name:CENTER FOR BEHAVIORAL MEDICINE & PSYCHOLOGICAL WELLNESS,INC.
Entity type:Organization
Organization Name:CENTER FOR BEHAVIORAL MEDICINE & PSYCHOLOGICAL WELLNESS,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:S
Authorized Official - Last Name:TRAUB
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:954-202-6200
Mailing Address - Street 1:150 SW 12TH AVE STE 207
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33069-3298
Mailing Address - Country:US
Mailing Address - Phone:954-202-6200
Mailing Address - Fax:954-202-6207
Practice Address - Street 1:150 SW 12TH AVE
Practice Address - Street 2:STE 207
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33069-3298
Practice Address - Country:US
Practice Address - Phone:954-202-6200
Practice Address - Fax:954-202-6207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-28
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0003620261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)