Provider Demographics
NPI:1760196109
Name:BOYNTON MENTAL HEALTH LLC
Entity type:Organization
Organization Name:BOYNTON MENTAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:R
Authorized Official - Last Name:BRONSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:561-396-9279
Mailing Address - Street 1:12765 FOREST HILL BLVD STE 1309
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-4781
Mailing Address - Country:US
Mailing Address - Phone:561-395-9279
Mailing Address - Fax:
Practice Address - Street 1:12765 FOREST HILL BLVD STE 1309
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-4781
Practice Address - Country:US
Practice Address - Phone:561-395-9279
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-10
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty