Active NPI
2ND Chance Mental Health Center, LLC
- Clinical Social Worker
- Port St Lucie, FL
National Provider Identifier
1942518246
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- SW9510
- Legal business name
- 2ND CHANCE MENTAL HEALTH CENTER, LLC
- Practice address
- 1541 SE Port St Lucie Blvd
Suite F
Port St Lucie, FL 34952-5456 - Phone
- (772) 335-0166
- NPI assigned
- Sep 21, 2010
- Last updated
- May 6, 2013
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Johnny Brown
- Title
- Ceo/Owner
- Phone
- (772) 335-0166
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | SW9510 | FL | Primary |
Addresses
Primary practice location
1541 SE Port St Lucie Blvd
Suite F
Port St Lucie, FL 34952-5456
Mailing address
1541 SE Port St Lucie Blvd
Suite F
Port St Lucie, FL 34952-5456
Phone (772) 335-0166
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 003355500 | Medicaid | FL |
National Provider Directory
National Provider Directory- Tax ID family
- 2ND Chance Mental Health Center LLC
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Community/Behavioral Health Agency
- Port Saint Lucie, FL
- NPI 1447554019
Locations
1541 SE Port St Lucie Blvd
Ste F
Port St Lucie, FL 34952
Phone (772) 335-0166
Practitioners & affiliated clinicians
Practitioners 3
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Social Worker
- Port St Lucie, FL
- NPI 1124367081
-
- Psychiatry Physician
- Fort Pierce, FL
- NPI 1851350029
-
- Social Worker
- Port St Lucie, FL
- NPI 1164761045
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1285027200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1367798400000",
"number": "1942518246",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1541 SE PORT ST LUCIE BLVD",
"address_2": "SUITE F",
"city": "PORT ST LUCIE",
"state": "FL",
"postal_code": "349525456",
"telephone_number": "772-335-0166"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1541 SE PORT ST LUCIE BLVD",
"address_2": "SUITE F",
"city": "PORT ST LUCIE",
"state": "FL",
"postal_code": "349525456",
"telephone_number": "772-335-0166"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "2ND CHANCE MENTAL HEALTH CENTER, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2010-09-21",
"last_updated": "2013-05-06",
"status": "A",
"authorized_official_last_name": "BROWN",
"authorized_official_first_name": "JOHNNY",
"authorized_official_title_or_position": "CEO/OWNER",
"authorized_official_telephone_number": "772-335-0166",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "FL",
"license": "SW9510",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "003355500",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Port St Lucie, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.