Provider Demographics
NPI:1184960171
Name:THERAPEUTIC OASIS OF THE PALM BEACHES
Entity type:Organization
Organization Name:THERAPEUTIC OASIS OF THE PALM BEACHES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D
Authorized Official - Phone:561-278-6033
Mailing Address - Street 1:851 BROKEN SOUND PARKWAY NW
Mailing Address - Street 2:SUITE 250
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487
Mailing Address - Country:US
Mailing Address - Phone:561-278-6033
Mailing Address - Fax:561-278-6023
Practice Address - Street 1:851 BROKEN SOUND PARKWAY NW
Practice Address - Street 2:SUITE 250
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487
Practice Address - Country:US
Practice Address - Phone:561-278-6033
Practice Address - Fax:561-278-6023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-18
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6439103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty