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Organization
CENTER FOR IDENTITY DEVELOPMENT SOUTH LTD INC
Active
Organization
CENTER FOR IDENTITY DEVELOPMENT SOUTH LTD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MICHELE LINDA LANESE LCSW (PRESIDENT CENTER FOR IDENTITY DEVEL)
(954) 345-5525
Entity
Organization
Contact information
Practice address
4855 W HILLSBORO BLVD, SUITE B1, COCONUT CREEK, FL 33073-4356
(954) 345-5525
(954) 977-4978
Mailing address
4855 W HILLSBORO BLVD, SUITE B1, COCONUT CREEK, FL 33073-4356
(954) 345-5525
(954) 977-4978
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
12/06/2006
Last updated
07/29/2014
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