Provider Demographics
NPI:1912320417
Name:SOUTH FLORIDA FAMILY TREATMENT
Entity Type:Organization
Organization Name:SOUTH FLORIDA FAMILY TREATMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:PECUCH
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:626-532-0789
Mailing Address - Street 1:6503 NW 66TH WAY
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33067-1415
Mailing Address - Country:US
Mailing Address - Phone:626-532-0789
Mailing Address - Fax:
Practice Address - Street 1:7301 W PALMETTO PARK RD
Practice Address - Street 2:SUITE 210C
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-3458
Practice Address - Country:US
Practice Address - Phone:561-368-0026
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-04
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7759251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health