Provider Demographics
NPI:1215341466
Name:PICKETT FENCES FAMILY STABILIZATION & MENTAL HEALTH SERVICS OF SO FL
Entity type:Organization
Organization Name:PICKETT FENCES FAMILY STABILIZATION & MENTAL HEALTH SERVICS OF SO FL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:PAULETTE
Authorized Official - Middle Name:R
Authorized Official - Last Name:ARLINE
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:954-486-8878
Mailing Address - Street 1:3800 INVERRARY BLVD
Mailing Address - Street 2:SUITE 401-C
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33319-4382
Mailing Address - Country:US
Mailing Address - Phone:954-486-8878
Mailing Address - Fax:888-516-7046
Practice Address - Street 1:3800 INVERRARY BLVD
Practice Address - Street 2:SUITE 401-C
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33319-4382
Practice Address - Country:US
Practice Address - Phone:954-486-8878
Practice Address - Fax:888-516-7046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-16
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty