Provider Demographics
NPI:1285946350
Name:SP BEHAVIORAL LLC
Entity type:Organization
Organization Name:SP BEHAVIORAL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCARTHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-744-0211
Mailing Address - Street 1:11301 SE TEQUESTA TER
Mailing Address - Street 2:
Mailing Address - City:TEQUESTA
Mailing Address - State:FL
Mailing Address - Zip Code:33469-8146
Mailing Address - Country:US
Mailing Address - Phone:561-744-0211
Mailing Address - Fax:561-972-4481
Practice Address - Street 1:11301 SE TEQUESTA TER
Practice Address - Street 2:
Practice Address - City:TEQUESTA
Practice Address - State:FL
Practice Address - Zip Code:33469-8146
Practice Address - Country:US
Practice Address - Phone:561-744-0211
Practice Address - Fax:561-972-4481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-06
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH246893336C0003X
3336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5701974OtherNCPDP PROVIDER IDENTIFICATION NUMBER