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Organization
MODERN REALITY
Active
Organization
MODERN REALITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CASEY BRANNIGAN (OWNER)
(561) 402-9655
Entity
Organization
Contact information
Practice address
200 KNUTH RD STE 101, BOYNTON BEACH, FL 33436-4635
(561) 402-9655
Mailing address
200 KNUTH RD STE 101, BOYNTON BEACH, FL 33436-4635
(561) 402-9655
Taxonomy
Speciality
Code
Description
License number
State
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
—
NULL
Other
Enumeration date
06/18/2019
Last updated
06/18/2019
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