Organization Active NPI

Legacy Behavioral Health Center, Inc

  • Clinical Social Worker
  • Vero Beach, FL
National Provider Identifier
1477828887
Registry record updated Mar 19, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
LEGACY BEHAVIORAL HEALTH CENTER, INC
Practice address
1945 22ND Ave
Vero Beach, FL 32960-3083
Phone
(772) 646-1682
Fax
(772) 257-5265
NPI assigned
Mar 19, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 19, 2012

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

Authorized official

Name
Mr. Ivan Jimenez
Title
Human Resources
Phone
(561) 712-8821

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X Primary

Addresses

Primary practice location

1945 22ND Ave
Vero Beach, FL 32960-3083

Mailing address

1551 Forum PL
400 D&E
West Palm Beach, FL 33401-2319

National Provider Directory

National Provider Directory

Locations

1551 Forum Pl
#400
West Palm Beach, FL 33401

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1332115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1332115200000",
    "number": "1477828887",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1551 FORUM PL",
            "address_2": "400 D&E",
            "city": "WEST PALM BEACH",
            "state": "FL",
            "postal_code": "334012319"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1945 22ND AVE",
            "city": "VERO BEACH",
            "state": "FL",
            "postal_code": "329603083",
            "telephone_number": "772-646-1682",
            "fax_number": "772-257-5265"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY BEHAVIORAL HEALTH CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-19",
        "last_updated": "2012-03-19",
        "status": "A",
        "authorized_official_last_name": "JIMENEZ",
        "authorized_official_first_name": "IVAN",
        "authorized_official_title_or_position": "HUMAN RESOURCES",
        "authorized_official_telephone_number": "561-712-8821",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vero Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2012; 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.