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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