Pediatric Behavioral Health Associates, Inc.

Primary specialty

Case Manager/Care CoordinatorTaxonomy code 171M00000X

Legal business name

PEDIATRIC BEHAVIORAL HEALTH ASSOCIATES, INC.

Practice address

5818 SE Agnew Rd
Belleview, FL 34420-4020

Phone

(561) 706-1004

Fax

(561) 892-0268

NPI assigned

May 12, 2020

Organization subpart

No

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

Authorized official

Name

Dr. Nicole M Woller, PHD, LCSW

Title

President

Phone

(561) 706-1004

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

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.

• Pediatric Behavioral Health Associates, Inc.

  • Adolescent and Children Mental Health Clinic/Center
  • Belleview, FL
  • NPI 1174385470
  NPD tax ID
• Pediatric Behavioral Health Associates, Inc.

  • Clinical Social Worker
  • Belleview, FL
  • NPI 1861953523
  NPD tax ID

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

{
    "created_epoch": "1589241600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710892800000",
    "number": "1881216877",
    "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": "561-706-1004",
            "fax_number": "561-892-0268"
        },
        {
            "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": "561-706-1004",
            "fax_number": "561-892-0268"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC BEHAVIORAL HEALTH ASSOCIATES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-12",
        "last_updated": "2024-03-20",
        "certification_date": "2024-03-20",
        "status": "A",
        "authorized_official_last_name": "WOLLER",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_middle_name": "M",
        "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": "171M00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102843600",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "WWW.NIKKIWOLLER.COM",
            "affiliation": "N",
            "address_1": "5818 SE Agnew Rd",
            "city": "Belleview",
            "state": "FL",
            "country_code": "US",
            "postal_code": "344204020",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Brianna N Parker, RBT
• Mukti B Patel, PA-C
• Emily Ann Pearce
• Pediatric Behavioral Health Associates, Inc.
• Pediatric Behavioral Health Associates, Inc.
• Rosa Pedreschi
• Gloria Ann Pena, ARNP
• Luis Perez
• Michael J Pettella, DC
• Pinard Home Health Services, LLC

• Case Manager/Care Coordinator in Belleview, FL
• Providers in Belleview, FL by specialty
• Case Manager/Care Coordinator in Florida

• 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.