Center for Identity Development South LTD Inc

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

CENTER FOR IDENTITY DEVELOPMENT SOUTH LTD INC

Practice address

4855 W Hillsboro Blvd
Suite B1
Coconut Creek, FL 33073-4356

Phone

(954) 345-5525

Fax

(954) 977-4978

NPI assigned

Dec 6, 2006

Organization subpart

No

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

Authorized official

Name

Ms. Michele Linda Lanese, LCSW

Title

President Center for Identity Devel

Phone

(954) 345-5525

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1165363200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1406592000000",
    "number": "1295894301",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4855 W HILLSBORO BLVD",
            "address_2": "SUITE B1",
            "city": "COCONUT CREEK",
            "state": "FL",
            "postal_code": "330734356",
            "telephone_number": "954-345-5525",
            "fax_number": "954-977-4978"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4855 W HILLSBORO BLVD",
            "address_2": "SUITE B1",
            "city": "COCONUT CREEK",
            "state": "FL",
            "postal_code": "330734356",
            "telephone_number": "954-345-5525",
            "fax_number": "954-977-4978"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTER FOR IDENTITY DEVELOPMENT SOUTH LTD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-06",
        "last_updated": "2014-07-29",
        "status": "A",
        "authorized_official_last_name": "LANESE",
        "authorized_official_first_name": "MICHELE",
        "authorized_official_middle_name": "LINDA",
        "authorized_official_title_or_position": "PRESIDENT CENTER FOR IDENTITY DEVEL",
        "authorized_official_telephone_number": "954-345-5525",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Clinic/Center (Including Community Mental Health Center) in Coconut Creek, FL
• Providers in Coconut Creek, FL by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2014; 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.