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Organization

PEDIATRIC BEHAVIORAL HEALTH ASSOCIATES, INC.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. NICOLE M WOLLER PHD, LCSW (PRESIDENT)
(561) 706-1004
Entity
Organization

Contact information

Practice address
5818 SE AGNEW RD, BELLEVIEW, FL 34420-4020
(561) 706-1004
(561) 892-0268
Mailing address
2735 SE 140TH PL, SUMMERFIELD, FL 34491-2877
(561) 706-1004
(561) 892-0268

Taxonomy

Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
102843600
FL
Enumeration date
05/12/2020
Last updated
03/20/2024
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