NPIMap

Organization Active NPI

Pediatric Behavioral Health Associates, Inc.

  • Adolescent and Children Mental Health Clinic/Center
  • Belleview, FL
National Provider Identifier
1174385470
Registry record updated Mar 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X
Legal business name
PEDIATRIC BEHAVIORAL HEALTH ASSOCIATES, INC.
Practice address
5818 SE Agnew Rd
Belleview, FL 34420-4020
Phone
(561) 715-5910
NPI assigned
Jan 23, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 20, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Nicole Woller, PHD, LCSW
Title
President
Phone
(561) 706-1004

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adolescent and Children Mental Health Clinic/Center 261QM0855X Primary

Addresses

Primary practice location

5818 SE Agnew Rd
Belleview, FL 34420-4020

Mailing address

2735 SE 140TH PL
Summerfield, FL 34491-2877
Phone (561) 715-5910

National Provider Directory

National Provider Directory
Tax ID family
Pediatric Behavioral Health Associates Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

5818 SE Agnew Rd
Belleview, FL 34420
Phone (561) 706-1004

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1705968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710892800000",
    "number": "1174385470",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2735 SE 140TH PL",
            "city": "SUMMERFIELD",
            "state": "FL",
            "postal_code": "344912877",
            "telephone_number": "561-715-5910"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5818 SE AGNEW RD",
            "city": "BELLEVIEW",
            "state": "FL",
            "postal_code": "344204020",
            "telephone_number": "561-715-5910"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC BEHAVIORAL HEALTH ASSOCIATES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-23",
        "last_updated": "2024-03-20",
        "certification_date": "2024-03-20",
        "status": "A",
        "authorized_official_last_name": "WOLLER",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "561-706-1004",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD, LCSW"
    },
    "taxonomies": [
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Belleview, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.