Provider Demographics
NPI:1922835669
Name:PEDIATRIC INSTITUTE FOR HEALTH AND WELLNESS
Entity type:Organization
Organization Name:PEDIATRIC INSTITUTE FOR HEALTH AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:844-550-7337
Mailing Address - Street 1:1002 SE MONTEREY COMMONS BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34996-3357
Mailing Address - Country:US
Mailing Address - Phone:844-550-7337
Mailing Address - Fax:772-264-9820
Practice Address - Street 1:1002 SE MONTEREY COMMONS BLVD STE 203
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34996-3357
Practice Address - Country:US
Practice Address - Phone:844-550-7337
Practice Address - Fax:772-264-9820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No2084P0005XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurodevelopmental DisabilitiesGroup - Multi-Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty