Provider Demographics
NPI:1952734873
Name:PALM BEACH PROFESSIONAL GROUP, PC
Entity Type:Organization
Organization Name:PALM BEACH PROFESSIONAL GROUP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FACILITY CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:CALARCO
Authorized Official - Suffix:
Authorized Official - Credentials:D O
Authorized Official - Phone:615-712-5862
Mailing Address - Street 1:200 POWELL PL
Mailing Address - Street 2:ATTN: LEGAL DEPARTMENT
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-7514
Mailing Address - Country:US
Mailing Address - Phone:615-732-1605
Mailing Address - Fax:
Practice Address - Street 1:4400 E CONGRESS AVE
Practice Address - Street 2:STE. 201
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407
Practice Address - Country:US
Practice Address - Phone:615-727-8387
Practice Address - Fax:615-457-8094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-14
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8361103T00000X
FLPY8421103T00000X
FL2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty