Provider Demographics
NPI:1699947275
Name:PUBLIC ENRICHMENT & RESOURCE CENTER INC.
Entity type:Organization
Organization Name:PUBLIC ENRICHMENT & RESOURCE CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:M
Authorized Official - Last Name:WOLLER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:561-706-1004
Mailing Address - Street 1:7300 W CAMINO REAL
Mailing Address - Street 2:STE 233
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-5512
Mailing Address - Country:US
Mailing Address - Phone:561-706-1004
Mailing Address - Fax:561-892-0268
Practice Address - Street 1:7300 W CAMINO REAL
Practice Address - Street 2:STE 233
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-5512
Practice Address - Country:US
Practice Address - Phone:561-706-1004
Practice Address - Fax:561-892-0268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-24
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW5325251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health