Provider Demographics
NPI:1952610818
Name:CHILD AND FAMILY THERAPY ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:CHILD AND FAMILY THERAPY ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:C
Authorized Official - Last Name:JACOBSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:561-371-1885
Mailing Address - Street 1:600 SANDTREE DR
Mailing Address - Street 2:SUITE 209
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33403-1597
Mailing Address - Country:US
Mailing Address - Phone:561-371-1885
Mailing Address - Fax:561-355-8365
Practice Address - Street 1:600 SANDTREE DR
Practice Address - Street 2:SUITE 209
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33403-1597
Practice Address - Country:US
Practice Address - Phone:561-371-1885
Practice Address - Fax:561-355-8365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-27
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL30331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ5084OtherBC/BS