Provider Demographics
NPI:1831297704
Name:BEHAVIORAL MEDICINE ASSOCIATES OF SW FLORIDA PA
Entity Type:Organization
Organization Name:BEHAVIORAL MEDICINE ASSOCIATES OF SW FLORIDA PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:E
Authorized Official - Last Name:FABACHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-261-8188
Mailing Address - Street 1:700 2ND AVE N
Mailing Address - Street 2:SUITE 302
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5756
Mailing Address - Country:US
Mailing Address - Phone:239-261-8188
Mailing Address - Fax:239-261-9144
Practice Address - Street 1:700 2ND AVE N
Practice Address - Street 2:SUITE 302
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5756
Practice Address - Country:US
Practice Address - Phone:239-261-8188
Practice Address - Fax:239-261-9144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 00559282084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty