Provider Demographics
NPI:1407683907
Name:MENTAL HEALTH NEAR ME PROFESSIONAL LIMITED LIABILITY COMPANY
Entity type:Organization
Organization Name:MENTAL HEALTH NEAR ME PROFESSIONAL LIMITED LIABILITY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANA
Authorized Official - Middle Name:
Authorized Official - Last Name:PATSIORNIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-732-2327
Mailing Address - Street 1:1314 E LAS OLAS BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-2334
Mailing Address - Country:US
Mailing Address - Phone:954-329-1464
Mailing Address - Fax:
Practice Address - Street 1:200 S. ANDREWS AVE,
Practice Address - Street 2:SUITE #504
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301
Practice Address - Country:US
Practice Address - Phone:954-329-1464
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-18
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center