Organization
BENJAMIN OUTREACH MEDICAL NETWORK CORPORATION
Active
Organization
BENJAMIN OUTREACH MEDICAL NETWORK CORPORATION
Active
Other names
BENJAMIN WELLNESS CENTER OF HOLLYWOOD
Organization subpart
No
Provider details
NPI number
Authorized official
ILNISE MATHIEU (OFFICE MANAGER)
(954) 251-0267
Entity
Organization
Contact information
Practice address
3939 HOLLYWOOD BLVD STE 1B, HOLLYWOOD, FL 33021-6749
(954) 251-0267
(754) 212-0473
Mailing address
3939 HOLLYWOOD BLVD STE 1B, HOLLYWOOD, FL 33021-6749
(954) 251-0267
(954) 239-7987
Taxonomy
Speciality
Code
Description
License number
State
103TA0700X
Adult Development & Aging Psychologist
—
—
103TF0000X
Family Psychologist
—
—
103TP2701X
Group Psychotherapy Psychologist
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QC1500X
Community Health Clinic/Center
—
—
261QH0100X
Health Service Clinic/Center
Primary
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QP2300X
Primary Care Clinic/Center
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
279510800
—
FL
Enumeration date
09/06/2011
Last updated
07/04/2025
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