Provider Demographics
NPI:1912163932
Name:SOUTH BREVARD BEHAVIORAL MEDICINE
Entity Type:Organization
Organization Name:SOUTH BREVARD BEHAVIORAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:M
Authorized Official - Last Name:KAPLAN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:321-675-3474
Mailing Address - Street 1:1501 ROBERT J CONLAN BLVD NE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905-3502
Mailing Address - Country:US
Mailing Address - Phone:321-676-3474
Mailing Address - Fax:321-676-3412
Practice Address - Street 1:1501 ROBERT J CONLAN BLVD NE
Practice Address - Street 2:SUITE 150
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-3502
Practice Address - Country:US
Practice Address - Phone:321-676-3474
Practice Address - Fax:321-676-3412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-29
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY3736251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL73318Medicare PIN