Provider Demographics
NPI:1730875923
Name:PRIVATE MENTAL HEALTH GROUP, LLC
Entity type:Organization
Organization Name:PRIVATE MENTAL HEALTH GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:
Authorized Official - Last Name:KATZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-494-4975
Mailing Address - Street 1:3100 N OCEAN BLVD APT 603
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-7188
Mailing Address - Country:US
Mailing Address - Phone:646-512-3203
Mailing Address - Fax:754-800-2610
Practice Address - Street 1:12 SE 7TH ST STE 705
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-3469
Practice Address - Country:US
Practice Address - Phone:954-794-9000
Practice Address - Fax:754-800-2610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-12
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty