Provider Demographics
NPI:1710382213
Name:MENTAL HEALTH SERVICES OF DELRAY BEACH
Entity Type:Organization
Organization Name:MENTAL HEALTH SERVICES OF DELRAY BEACH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:IACULLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-270-2361
Mailing Address - Street 1:223 NE 5TH AVE STE 103A
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33483-5530
Mailing Address - Country:US
Mailing Address - Phone:561-270-2361
Mailing Address - Fax:561-270-2081
Practice Address - Street 1:223 NE 5TH AVE STE 103A
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33483-5530
Practice Address - Country:US
Practice Address - Phone:561-270-2361
Practice Address - Fax:561-270-2081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-27
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)