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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