Provider Demographics
NPI:1275924979
Name:FL CENTER FOR COMPULSIVE & ADDICTIVE BEHAVIORS, LLC
Entity Type:Organization
Organization Name:FL CENTER FOR COMPULSIVE & ADDICTIVE BEHAVIORS, LLC
Other - Org Name:FORT LAUDERDALE BEHAVIOR THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MITCHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSENHOLTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:561-501-1725
Mailing Address - Street 1:2630 E OAKLAND PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33306-1603
Mailing Address - Country:US
Mailing Address - Phone:561-501-1725
Mailing Address - Fax:
Practice Address - Street 1:2630 E OAKLAND PARK BLVD
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33306-1603
Practice Address - Country:US
Practice Address - Phone:561-501-1725
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-17
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW93081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty