Provider Demographics
NPI:1770746851
Name:TRADELPHIS LLC
Entity type:Organization
Organization Name:TRADELPHIS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHANTAL
Authorized Official - Middle Name:M
Authorized Official - Last Name:GAGNON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, MA, LMHC
Authorized Official - Phone:954-559-2936
Mailing Address - Street 1:7378 W ATLANTIC BLVD
Mailing Address - Street 2:SUITE 388
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-4214
Mailing Address - Country:US
Mailing Address - Phone:954-559-2936
Mailing Address - Fax:
Practice Address - Street 1:600 N PINE ISLAND RD
Practice Address - Street 2:SUITE 450
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-1393
Practice Address - Country:US
Practice Address - Phone:954-559-2936
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-08
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH9510261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)