Provider Demographics
NPI:1346721917
Name:SENIOR LIVING BEHAVIORAL HEALTH, PLLC
Entity Type:Organization
Organization Name:SENIOR LIVING BEHAVIORAL HEALTH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROTTER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:516-448-1382
Mailing Address - Street 1:747 3RD AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-2878
Mailing Address - Country:US
Mailing Address - Phone:516-448-1382
Mailing Address - Fax:973-839-3653
Practice Address - Street 1:300 CABANA CAY CIR
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32413-4684
Practice Address - Country:US
Practice Address - Phone:516-448-1382
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW155871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty