Provider Demographics
NPI:1083968721
Name:COMPREHENSIVE PSYCHOTHERAPY NETWORK,INCORPORATED
Entity Type:Organization
Organization Name:COMPREHENSIVE PSYCHOTHERAPY NETWORK,INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:KAREN
Authorized Official - Last Name:PERSENAIRE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:561-967-3266
Mailing Address - Street 1:1825 FOREST HILL BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33406-8902
Mailing Address - Country:US
Mailing Address - Phone:561-967-3266
Mailing Address - Fax:561-968-1565
Practice Address - Street 1:1825 FOREST HILL BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406-8902
Practice Address - Country:US
Practice Address - Phone:561-967-3266
Practice Address - Fax:561-968-1565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-02
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW0008661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ1858OtherMEDICARE PTAN