Provider Demographics
NPI:1689903650
Name:SOUTHWEST FLORIDA ASSOCIATES IN MENTAL HEALTH AND ADDICTIONS, P.A.
Entity Type:Organization
Organization Name:SOUTHWEST FLORIDA ASSOCIATES IN MENTAL HEALTH AND ADDICTIONS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:ANTHONY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:239-940-1804
Mailing Address - Street 1:12657 NEW BRITTANY BLVD
Mailing Address - Street 2:SUITE 12
Mailing Address - City:FORT MEYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-3631
Mailing Address - Country:US
Mailing Address - Phone:239-940-1804
Mailing Address - Fax:239-275-3964
Practice Address - Street 1:12657 NEW BRITTANY BLVD
Practice Address - Street 2:SUITE 12
Practice Address - City:FORT MEYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-3631
Practice Address - Country:US
Practice Address - Phone:239-940-1804
Practice Address - Fax:239-275-3964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-21
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0003960251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health