Provider Demographics
NPI:1558445288
Name:FLORIDA DEPARTMENT OF CHILDREN AND FAMILIES
Entity Type:Organization
Organization Name:FLORIDA DEPARTMENT OF CHILDREN AND FAMILIES
Other - Org Name:NORTHEASTFLORIDASTATEHOSPITALCOMMUNITYBEHAVIORALHEALTHCARESERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATIONS CONSULTANT MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TONIA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:BRANCH
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC,NCC,CAP
Authorized Official - Phone:904-259-4671
Mailing Address - Street 1:84 W LOWDER ST STE C
Mailing Address - Street 2:
Mailing Address - City:MACCLENNY
Mailing Address - State:FL
Mailing Address - Zip Code:32063-2638
Mailing Address - Country:US
Mailing Address - Phone:904-259-4671
Mailing Address - Fax:904-259-5187
Practice Address - Street 1:84 W LOWDER ST STE C
Practice Address - Street 2:
Practice Address - City:MACCLENNY
Practice Address - State:FL
Practice Address - Zip Code:32063-2638
Practice Address - Country:US
Practice Address - Phone:904-259-4671
Practice Address - Fax:904-259-5187
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FLORIDA DEPARTMENT OF CHILDREN AND FAMILIES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251B00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL070483100Medicaid
FL910220500Medicaid