Organization
LEGACY BEHAVIORAL HEALTH CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ALICIA B. PAJARES LCSW (PRESIDENT)
(561) 722-7866
Entity
Organization
Contact information
Practice address
15818 SW WARFIELD BLVD, INDIANTOWN, FL 34956-3513
(772) 597-0411
(772) 597-0412
Mailing address
PO BOX 458, INDIANTOWN, FL 34956-0458
(772) 597-0411
(772) 597-0412
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
SW5271
FL
251S00000X
Community/Behavioral Health Agency
6427
FL
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
076140100
—
FL
01
—
600058153
MAGELLAN HMO
FL
Enumeration date
03/07/2006
Last updated
02/04/2020
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