Provider Demographics
NPI:1679972277
Name:SOUTH FLORIDA TREATMENT SOLUTIONS
Entity type:Organization
Organization Name:SOUTH FLORIDA TREATMENT SOLUTIONS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:FANALI
Authorized Official - Suffix:JR
Authorized Official - Credentials:LMHC, CAP
Authorized Official - Phone:561-596-1602
Mailing Address - Street 1:PO BOX 7924
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33482-7924
Mailing Address - Country:US
Mailing Address - Phone:561-360-9808
Mailing Address - Fax:
Practice Address - Street 1:1300 NW 17TH AVE
Practice Address - Street 2:SUITE 161
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-2578
Practice Address - Country:US
Practice Address - Phone:561-360-9808
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-19
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH12642251B00000X, 251S00000X
FL1550AD482601261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health