Organization
CRAFT BEHAVIORAL HEALTH, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MOHAMMAD FAROOQUE MD, PH.D. (PRESIDENT)
(904) 379-5928
Entity
Organization
Contact information
Practice address
10175 FORTUNE PKWY, SUITE #1106, JACKSONVILLE, FL 32256-6746
(904) 379-5928
(904) 379-5967
Mailing address
10175 FORTUNE PKWY, SUITE #1106, JACKSONVILLE, FL 32256-6746
(904) 379-5928
(904) 379-5967
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1455P
BC/BS OF FL
FL
Enumeration date
02/18/2010
Last updated
07/21/2011
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