Network County: Alachua Family Preservation Services of FL (CMHC) Community Mental Health Centers Camelot Community Care Inc (CMHC) 2233 Nw 41st St Suite 700 F Gainesville, FL 32606 7483 County: Alachua Medicaid No: 761509400 Phone: (352)671 7884 (850)561 1143 CDS Family & Behavioral Health (CMHC) 3615 SW 13th Street Suite 4 Gainesville, FL 32608 3540 County: Alachua Medicaid No: NOF Phone: (352)244 0628 (352)244 0668 Childrens Home Society (CMHC) 711 NW 1st St Gainesville, FL 32601 5343 County: Alachua Medicaid No: 004823200 Phone: (866)427 5451 1731 NW 6th Street Suite A 1 Gainesville, FL 32609 8554 County: Alachua Medicaid No: 008760300 Phone: (352)264 8152 (352)375 6402 LAWRENCE ADU (MD) 103 SW2nd Avenue Gainesville, FL 32601 3316 County: Alachua Medicaid No: 274635200 Phone: (352)378 9116 (352)378 9779 Jing Liu (MD) 6500 W Newberry Road Gainesville, FL 32605 4309 County: Alachua Medicaid No: 004483000 Psychiatrists Phone: (352)333 4000 (352)333 4800 Wednesday, December 09, 2015 Page 1 of 134
Network County: Bay County: Brevard Community Mental Health Centers Community Mental Health Centers Childrens Home Society (CMHC) Childrens Home Society (CMHC) 914 Harrison Ave Panama City, FL 32401 2528 County: Bay Medicaid No: 004823200 Phone: (850)747 5411 (850)872 7245 326 Croton Road Melbourne, FL 32935 6340 County: Brevard Medicaid No: 004823200 Phone: (321)752 3170 (321)752 3179 Florida Therapy Services Inc (CMHC) Circles of Care Inc (CMHC) 2711 W. 15th Street Panama City, FL 32401 1366 County: Bay Medicaid No: 913786600 Phone: (850)769 6001 (850)769 6003 1770 Cedar Street Rockledge, FL 32955 3133 County: Brevard Medicaid No: 60291400 Phone: (321)890 1500 Hospitals/Clinics Emerald Coast Behavioral Hospital (HOSP) 1940 Harrison Avenue Panama City, FL 32405 4542 County: Bay Medicaid No: 008135300 Phone: (850)763 0017 (850)785 0580 Circles of Care Inc (CMHC) 2000 Commerce Dr Melbourne, FL 32904 2335 County: Brevard Medicaid No: 60291400 Phone: (321)676 6650 (321)953 7510 Wednesday, December 09, 2015 Page 2 of 134
Network Circles of Care Inc (CMHC) Circles of Care Inc (CMHC) 2020 Commerce Dr Melbourne, FL 32904 2335 County: Brevard Medicaid No: 60291400 Phone: (321)952 6000 6700 South Washington Ave Titusville, FL 32780 8050 County: Brevard Medicaid No: 60291400 Phone: (321)269 4590 Circles of Care Inc (CMHC) Circles of Care Inc (CMHC) 400 East Sheridan Rd Melbourne, FL 32901 3122 County: Brevard Medicaid No: 60291400 Phone: (321)722 5200 880 Airport Rd. Melbourne, FL 32901 2909 County: Brevard Medicaid No: 60291400 Phone: (321)722 5200 Circles of Care Inc (CMHC) Coastal Mental Health Center (CMHC) 4450 West Eau Gallie Blvd Suite 200 Melbourne, FL 32934 7214 County: Brevard Medicaid No: 60291400 Phone: (321)722 5200 197 Bougainvillea Dr. Suite A Rockledge, FL 32955 2402 County: Brevard Medicaid No: 000959600 Phone: (800)614 4124 (888)217 4124 Wednesday, December 09, 2015 Page 3 of 134
Network Coastal Mental Health Center (CMHC) Devereux Foundation Viera (CMHC) 4620 Lipscomb St Suite 3 Palm Bay, FL 32905 2934 County: Brevard Medicaid No: 000959600 Phone: (800)614 4124 (888)217 4124 8000 Devereux Drive Melbourne, FL 32940 7907 County: Brevard Medicaid No: 004811800 Phone: (866)440 0613 (866)440 0613 Devereux Foundation Brevard Grp Home for Boys (CMHC) 225 N Burnett Road Cocoa, FL 32926 4242 County: Brevard Medicaid No: 004811800 Phone: (866)440 0613 (866)440 0613 Impower (CMHC) 1037 Pathfinder Way Suite 130 Rockledge, FL 32955 County: Brevard Medicaid No: 011247100 Phone: (321)639 1224 (407)261 0523 Devereux Foundation Brevard Grp Home for Girls (CMHC) 2330 Aurora Road Melbourne, FL 32935 3306 County: Brevard Medicaid No: 004811800 Phone: (866)440 0613 (866)440 0613 Cecilia Corrado (ARNP) Indialantic, FL 32903 4321 Nurse Practitioner 105 S. Rivverside Drive Suite 151 County: Brevard Medicaid No: 307023900 Phone: (321)345 4947 (321)345 4950 Psychiatrists Wednesday, December 09, 2015 Page 4 of 134
Network James Jacobson (MD) Devereux Foundation TCM Brevard (TCM) 2123 Franklin Dr NE Palm Bay, FL 32905 4022 County: Brevard Medicaid No: 265015100 Phone: (321)724 1614 (321)722 3590 1600 Sarno Road Suite 214 Melbourne, FL 32935 4993 County: Brevard Medicaid No: 004811800 Phone: (866)440 0613 (866)440 0613 Beatriz Villafane (MD) 2123 Franklin Dr NE Palm Bay, FL 32905 4022 County: Brevard Medicaid No: 006089200 Phone: (321)724 1614 (321)722 3590 Residential Treatment Centers Therapeutic Foster Care/Specialized Therapeutic Devereux Foundation Brevard Grp Home for Boys (STFC) 225 N Burnett Road Cocoa, FL 32926 4242 County: Brevard Medicaid No: 004811800 Phone: (866)440 0613 (866)440 0613 Devereux Foundation Viera (RTC) 8000 Devereux Drive Melbourne, FL 32940 7907 County: Brevard Medicaid No: 004811800 Phone: (866)440 0613 (866)440 0613 Devereux Foundation Brevard Grp Home for Girls (STFC) 2330 Aurora Road Melbourne, FL 32935 3306 County: Brevard Medicaid No: 004811800 Phone: (866)440 0613 (866)440 0613 Targeted Case Management Wednesday, December 09, 2015 Page 5 of 134
Network Devereux Foundation STFC Brevard (STFC) Butterfly Effects LLC (ABA) 1600 Sarno Road Suite 214 Melbourne, FL 32935 4993 County: Brevard Medicaid No: 004811800 Phone: (866)440 0613 (866)440 0613 500 Fairway Drive Suite 300 Lighthouse Point, FL 33064 7500 Medicaid No: 000513900 Phone: (954)603 7885 (954)342 0273 CREOLE RUSSIAN Devereux Foundation TFC Brevard (TFC) Cadenza Center For Psychotherapy (ABA) 1600 Sarno Road Suite 214 Melbourne, FL 32935 4993 County: Brevard Medicaid No: 004811800 Phone: (866)440 0613 (866)440 0613 450 N Park Rd Suite 400 Hollywood, FL 33021 6918 Medicaid No: NOF Phone: (954)925 3191 (954)925 3193 County: Broward ABA Facility Behavior Analysis Inc. (ABA) 8001 SW 36 Street Suite 9 Fort Lauderdale, FL 33328 1915 Medicaid No: NOF Phone: (786)597 2047 (305)284 6555 Children's Center for Development & Behavior (ABA) 440 Sawgrass Corporate Parkway Suite 106 Sunrise, FL 33325 6244 Medicaid No: 691637696 Phone: (954)745 1112 (954)745 1120 Wednesday, December 09, 2015 Page 6 of 134
Network Florida Comprehensive Autism Center (ABA) Progressive Behavioral Science (ABA) 2701 WEST OAKLAND PARK BLVD SUITE 310 Oakland Park, FL 33311 1389 Medicaid No: 009865400 Phone: (954)233 1810 (954)233 1815 3520 Oaks Way Suite 904 Pompano Beach, FL 33069 5387 Medicaid No: NOF Phone: (305)807 1909 (305)397 0308 Integrative Methods (ABA) 556 Nw 208 Way Pembroke Pines, FL 33029 2154 Medicaid No: 010045600 Phone: (954)249 0773 (954)391 8176 Omega Behavioral Consulting (ABA) 7420 NW 5TH STREET Plantation, FL 33317 1611 Medicaid No: NOF Phone: (786)374 5826 Community Mental Health Centers Active Community Health Center (CMHC) 1000 N Hiatus Road Suite 140 Pembroke Pines, FL 33026 3094 Medicaid No: 008779300 Phone: (954)333 8787 (954)450 2419 Advance Health and Commuity Serv (CMHC) 8910 Miramar Parkway Suite 306 Miramar, FL 33025 4182 Medicaid No: 010830000 Phone: (954)367 2840 (954)505 3378 Wednesday, December 09, 2015 Page 7 of 134
Network Agency for Community Treatment Serv (CMHC) Banyan Community Health Center Inc (CMHC) 1104 NE 13th Street Fort Lauderdale, FL 33304 1803 Medicaid No: 011246800 Phone: (954)598 0617 (954)598 0618 1061 W Oakland Park Blv Fort Lauderdale, FL 33309 1609 Medicaid No: 013881902 Phone: (305)774 3400 ARC Broward (CMHC) Bayview Center for Mental Health (CMHC) 10250 Nw 53rd Street Sunrise, FL 33351 8023 Medicaid No: 360366100 Phone: (954)746 9400 1300 Hibiscus Drive Pembroke Pines, FL 33025 4556 Medicaid No: 060279500 Phone: (954)966 4185 Archways Inc (CMHC) Bayview Center for Mental Health (CMHC) 919 NE 13th Street Fort Lauderdale, FL 33304 2009 Medicaid No: 753243100 Phone: (954)763 2030 (954)467 5844 1301 Poinciana Drive Pembroke Pines, FL 33025 4563 Medicaid No: 060279500 Phone: (954)966 4442 Wednesday, December 09, 2015 Page 8 of 134
Network Bayview Center for Mental Health (CMHC) Bayview Center for Mental Health (CMHC) 8001 SW 36 Street Suite 10 Davie, FL 33328 1915 Medicaid No: 060279500 Phone: (954)518 4080 8455 South Palm Drive Pembroke Pines, FL 33025 4537 Medicaid No: 060279500 Phone: (954)966 4442 Bayview Center for Mental Health (CMHC) Bougainvilla House (CMHC) 8375 South Palm Drive Pembroke Pines, FL 33025 4535 Medicaid No: 060279500 Phone: (954)966 4442 1727 SE 4th Ave Fort Lauderdale, FL 33316 2515 Medicaid No: Phone: (954)764 7337 (954)764 6283 Bayview Center for Mental Health (CMHC) Broward Community and Family Health (CMHC) 8401 South Palm Drive Pembroke Pines, FL 33025 4537 Medicaid No: 060279500 Phone: (954)966 4442 5010 Hollywood Blvd Suite 100B Hollywood, FL 33021 6557 Medicaid No: 680027100 Phone: (954)967 0028 (954)967 8141 Wednesday, December 09, 2015 Page 9 of 134
Network Broward County Board of County Comm (CMHC) Broward County Board of County Comm (CMHC) 1000 SW 2nd Street Fort Lauderdale, FL 33301 3658 Medicaid No: 005895200 Phone: (954)357 4880 (954)357 4853 3275 NW 99th Way Coral Springs, FL 33065 4024 Medicaid No: 005895200 Phone: (954)357 7940 (954)357 3925 Broward County Board of County Comm (CMHC) Broward County Board of County Comm (CMHC) 1011 SW 2nd Court Fort Lauderdale, FL 33312 7135 Medicaid No: 005895200 Phone: (954)357 4860 (594)357 4853 4733 SW 18th Street West Park, FL 33023 3307 Medicaid No: 005895200 Phone: (954)357 4851 (594)357 5695 Broward County Board of County Comm (CMHC) Camelot Community Care Inc (CMHC) 2995 North Dixie Hwy Oakland Park, FL 33334 2640 Medicaid No: 005895200 Phone: (954)357 6622 (954)357 8815 1925 South Perimeter Road Suite 120 Fort Lauderdale, FL 33309 7123 Medicaid No: 761509400 Phone: (954)958 0988 (954)958 3527 Wednesday, December 09, 2015 Page 10 of 134
Network Childrens Home Society (CMHC) Genesis Family Services LLC (CMHC) 401 NE 4th Street Ft Lauderdale, FL 33301 1151 Medicaid No: 004823200 Phone: (954)453 6400 (954)764 6458 5834 Stirling Road Hollywood, FL 33021 1527 Medicaid No: 003104500 Phone: (954)404 6261 (954)239 8612 CMETLLC (CMHC) Global Consultancy Group (CMHC) 1527 NE 4th Ave Fort Lauderdale, FL 33304 1035 Medicaid No: 006640100 Phone: (954)835 5741 (772)219 8196 CREOLE 4801 S. University Drive Suite 126 Davie, FL 33328 3832 Medicaid No: 012112700 Phone: (954)680 8777 (954)367 7760 Floridian Behavioral Healthcare LLC (CMHC) Henderson Behavioral Health (CMHC) 4699 N Federal Hwy Suite 104 Pompano Beach, FL 33064 6510 Medicaid No: 004884500 Phone: (954)580 3263 (954)366 1658 1957 Jackson Street Hollywood, FL 33020 5021 Medicaid No: 013848100 Phone: (954)921 2600 (954)927 2393 Wednesday, December 09, 2015 Page 11 of 134
Network Henderson Behavioral Health (CMHC) Henderson Behavioral Health (CMHC) 2677 NW 19th Street Fort Lauderdale, FL 33311 3340 Medicaid No: 013848100 Phone: (954)739 8066 (954)497 3857 3501 S University Drive Suite 6 Davie, FL 33328 2001 Medicaid No: 013848100 Phone: (954)888 7999 (954)497 3857 Henderson Behavioral Health (CMHC) Henderson Behavioral Health (CMHC) 2900 W Prospect Rd Fort Lauderdale, FL 33309 2519 Medicaid No: 013848100 Phone: (954)731 1000 (954)484 6554 3538 S. University Drive Davie, FL 33328 2003 Medicaid No: 013848100 Phone: (954)424 6911 (954)424 6915 Henderson Behavioral Health (CMHC) Henderson Behavioral Health (CMHC) 330 SW 27th Avenue Fort Lauderdale, FL 33312 2051 Medicaid No: 013848100 Phone: (954)791 4300 (954)791 7079 4700 N. State Road 7 Building A Suite 102 Lauderdale Lakes, FL 33319 5800 Medicaid No: 013848100 Phone: (954)735 9550 (954)497 1589 Wednesday, December 09, 2015 Page 12 of 134
Network Henderson Behavioral Health (CMHC) Memorial Adult Outpatient Behaviora (CMHC) 4720 N State Road 7 Lauderdale Lakes, FL 33319 5860 Medicaid No: 013848100 Phone: (954)463 0911 (954)463 4778 3400 N. 29th Ave Hollywood, FL 33020 1002 Medicaid No: NOF Phone: (954)965 6408 (954)965 6444 Henderson Behavioral Health (CMHC) Millenium Clinic Inc (CMHC) 5700 NW 27th Court Lauderhill, FL 33313 2389 Medicaid No: 013848100 Phone: (954)735 4331 (954)735 1214 1400 East Oakland Park Oakland Park, FL 33334 4400 Medicaid No: 011140700 Phone: (786)487 0433 Kids in Distress Inc (CMHC) Multicultural Alliance Health Care (CMHC) 819 NE 26th Street Wilton Manors, FL 33305 1239 Medicaid No: 760539100 Phone: (954)390 7654 (954)390 7618 2700 West Cypress Creek Road, Executive Court, Suite D 12 Fort Lauderdale, FL 33309 1744 Medicaid No: 004419200 Phone: (954)514 7659 (954)514 7569 Wednesday, December 09, 2015 Page 13 of 134
Network New Direction Institute Inc (CMHC) Pacific Case Management LLC (CMHC) 1509 N State Road 7 Suite C Margate, FL 33063 5731 Medicaid No: 675248901 Phone: (954)748 8444 (954)977 8394 7800 W Oakland Park Blvd Suite 107 Sunrise, FL 33351 1121 Medicaid No: 012143200 Phone: (305)873 9589 (954)323 6192 New Direction Institute Inc (CMHC) Parents Information and Resource Ce (CMHC) 6730 West Commerce Blvd Tamarac, FL 33319 2115 Medicaid No: 675248901 Phone: (954)748 8444 (954)748 7595 817 N. Dixie Highway Pompano Beach, FL 33060 5621 Medicaid No: 004811600 Phone: (954)785 8285 (954)928 0040 Our Children Our Future (CMHC) Reflections Wellness Center of Brow (CMHC) 2835 Hollywood Blvd Hollywood, FL 33020 Medicaid No: 070921200 Phone: (305)892 6161 (305)892 6167 6848 Stirling Road Pembroke Pines, FL 33024 1842 Medicaid No: 000288700 Phone: (954)362 0104 (954)364 4595 Wednesday, December 09, 2015 Page 14 of 134
Network Rega Mental Health Center (CMHC) Sunshine Social Services Inc (CMHC) 7501 Wiles Rd Suite 105 Coral Springs, FL 33067 2063 Medicaid No: 004971600 Phone: (954)341 1022 (954)341 1082 2312 Wilton Drive Fort Lauderdale, FL 33305 1249 Medicaid No: 3155600 Phone: (954)764 5150 (954)764 5143 Serenity Behavioral Health (CMHC) The Chrysalis Center (CMHC) 2303 Hollywood Blvd Suite 12 Hollywood, FL 33020 6768 Medicaid No: 011033500 Phone: (954)367 7944 (954)374 8311 3800 W Broward Blvd Suite 100 Ft Lauderdale, FL 33312 1018 Medicaid No: 008351800 Phone: (954)587 1008 (954)337 0938 Smith Community Mental Health (CMHC) The Starting Place (CMHC) 601 S State Rd 7 Plantation, FL 33317 4054 Medicaid No: 759948000 Phone: (954)321 2296 (954)321 5399 351 N. State Road 7 Suite 200 Plantation, FL 33317 2859 Medicaid No: 060045800 Phone: (954)327 4090 (954)792 9122 Wednesday, December 09, 2015 Page 15 of 134
Network Theracare Community Center (CMHC) Fort Lauderdale Hospital (HOSP) 7481 W Oakland Park Blvd Suite 302C Tamarac, FL 33319 4961 Medicaid No: 013424400 Phone: (954)256 4601 (954)491 4255 1601 E Las Olas Blvd Fort Lauderdale, FL 33301 2357 Medicaid No: 010357800 Phone: (954)463 4321 (954)453 5497 Third Step Behavioral Health Care (CMHC) Jackson Long Term Care Pharmacy (CLINIC) 200 SW 27th Avenue Suite 100 Fort Lauderdale, FL 33312 1223 Medicaid No: 005870000 Phone: (954)462 4489 (954)462 4490 759 NW 174th AVE PEMBROKE PINES, FL 33029 3145 Medicaid No: 103277100 Phone: (786)466 3020 CZECH SPANISH Hospitals/Clinics Atlantic Shores Hospital (HOSP) 4545 N Federal Hwy Fort Lauderdale, FL 33308 5203 Medicaid No: 015005400 Phone: (954)771 2711 (954)229 1202 Larkin Community Behavioral Health (HOSP) 1201 N 37th Ave Hollywood, FL 33021 5414 Medicaid No: 015775700 Phone: (954)962 1355 (954)777 5689 Wednesday, December 09, 2015 Page 16 of 134
Network Memorial Hospital Miramar (HOSP) Memorial Regional Hospital (HOSP) 1901 SW 172nd Ave Miramar, FL 33029 Medicaid No: 010345400 Phone: (954)538 4800 1150 N 35th Ave Suite 170 Hollywood, FL 33021 5424 Medicaid No: 038184507 Phone: (954)987 2000 Memorial Hospital Pembroke (HOSP) North Shore Medical Center FMC Camp (HOSP) 7800 Sheridan St Pembroke Pines, FL 33024 Medicaid No: 010222900 Phone: (954)883 8401 5000 West Oakland Park Blvd. Lauderdale Lakes, FL 33313 1503 Medicaid No: 010049807 Phone: (954)735 6000 (954)677 2602 Memorial Hospital West (HOSP) PHT JMH Transplant (HOSP) 703 N Flamingo Rd Pembroke Pines, FL 33028 Medicaid No: 010252100 Phone: (954)436 5000 1600 S ANDREWS AVE FT LAUDERDALE, FL Medicaid No: NOF Phone: (305)585 8957 CREOLE Wednesday, December 09, 2015 Page 17 of 134
Network University Hosp & Medical Center (HOSP) James Foster (ARNP) 7201 N University Drive Tamarac, FL 33321 2913 Medicaid No: 009735200 Phone: (954)721 2200 (954)724 6567 1881 NE 26 Street Suite 102 Wilton Manors, FL 33305 1427 Medicaid No: 012956200 Phone: (954)806 3434 (954)495 8592 Gloria Cardozo (ARNP) Hollywood, FL 33029 Nurse Practitioner 18501 Pembroke Pines Blvd. Suite 209 Medicaid No: 308719100 Phone: (954)437 2118 (954)432 3188 Kandace Eagle (ARNP) 1601 N Palm Ave Suite 211 Pembroke Pines, FL 33026 3204 Medicaid No: 004296900 Phone: (888)852 6672 (954)447 0899 Marjorie Gillespie Johnson (ARNP) 2500 N University Dr. Suite 2 Sunrise, FL 33322 3003 Medicaid No: 007241600 Phone: (954)431 7676 (888)538 2226 Heather Holder (ARNP) 3800 W Broward Blvd Suite 100 Fort Lauderdale, FL 33312 1018 Medicaid No: 304682600 Phone: (954)587 1008 (954)337 0938 Wednesday, December 09, 2015 Page 18 of 134
Network Heather Holder (ARNP) Joanne Willis (ARNP) 919 NE 13th Street Fort Lauderdale, FL 33304 2009 Medicaid No: 304682600 Phone: (954)763 2030 (954)467 5844 1601 N Palm Ave Suite 211 Pembroke Pines, FL 33026 3204 Medicaid No: 009469300 Phone: (888)852 6672 (954)447 0899 Kimberly Palazzolo (ARNP) 1601 N Palm Ave Suite 211 Pembroke Pines, FL 33026 3204 Medicaid No: 300295100 Phone: (888)852 6672 (954)447 0899 Kimberly Palazzolo (ARNP) 3816 Hollywood Blvd Suite 202 Hollywood, FL 33021 6750 Medicaid No: 300295100 Phone: (954)987 2900 Robert Antoine (MD) Psychiatrists 2501 E Commercial Blvd Suite 211 Fort Lauderdale, FL 33308 4127 Medicaid No: 008681500 Phone: (954)533 5700 (954)306 8686 FRENCH SPANISH CREOLE Ashish Bhatt (MD) 1527 NE 4th Ave Fort Lauderdale, FL 33304 1035 Medicaid No: 281257600 Phone: (954)835 5741 (772)219 8196 Wednesday, December 09, 2015 Page 19 of 134
Network Jacqueline Boutrouille (MD) Serge Celestin (MD) 7880 N University Drive Suite 303 Tamarac, FL 33321 2124 Medicaid No: 005337900 Phone: (954)340 3000 (954)636 8407 FRENCH SPANISH 1725 N. University Drive Suite 350 Coral Springs, FL 33071 6000 Medicaid No: 008682300 Phone: (954)227 2700 (954)227 2704 FRENCH CREOLE Maria Cabrera (MD) Antonio DeFilippo (MD) 1601 N Palm Ave Suite 211 Pembroke Pines, FL 33026 3204 Medicaid No: 066473100 Phone: (888)852 6672 (954)447 0899 2225 N University Dr Pembroke Pines, FL 33024 3611 Medicaid No: 377771500 Phone: (954)962 6200 (954)962 5495 Maximiliano Cardozo (MD) Richard Douyon (MD) 18501 Pembroke Pines Blvd. Suite 209 Hollywood, FL 33029 Medicaid No: 008682100 Phone: (954)437 2118 (954)432 3188 18503 Pines Blvd Suite 214 Pembroke Pines, FL 33029 1408 Medicaid No: 007499500 Phone: (954)432 3800 (866)404 8639 FRENCH Wednesday, December 09, 2015 Page 20 of 134
Network Jessica Evelson (MD) Paula Ann Marcelle Francis (MD) 7481 W Oakland Park Blvd Suite 100 Lauderhill, FL 33319 4985 Medicaid No: 009513900 Phone: (888)852 6672 (954)771 7748 1625 N. Commerce Parkway Suite 210 Weston, FL 33326 3206 Medicaid No: 004538800 Phone: (954)681 1818 (866)611 9649 David Flaherty (MD) Paula Ann Marcelle Francis (MD) 7481 W Oakland Park Blvd Suite 100 Lauderhill, FL 33319 4985 Medicaid No: 264634000 Phone: (888)852 6672 (954)771 7748 2501 East Commercial Blvd Suite 211 Ft Lauderdale, FL 33308 4127 Medicaid No: 004538800 Phone: (954)681 1818 (866)611 9649 Abraham Flemenbaum (MD) Diana Glaccum Gavagni (MD) 1000 N Hiatus Road Suite 140 Pembroke Pines, FL 33026 3094 Medicaid No: 008683200 Phone: (954)431 9838 (954)433 7066 HEBREW 2699 Stirling RD Suite C 105 Fort Lauderdale, FL 33312 6546 Medicaid No: 001754800 Phone: (954)983 2030 (305)558 6134 Wednesday, December 09, 2015 Page 21 of 134
Network Stephen Hubbard (DO) Mohammad Latif Jangda (MD) 1601 N Palm Ave Suite 211 Pembroke Pines, FL 33026 3204 Medicaid No: 013224400 Phone: (888)852 6672 (954)447 0899 8050 N University Drive Suite 201 Tamarac, FL 33321 2102 Medicaid No: 001448700 Phone: (954)532 2920 (954)581 5630 URDU PUNJABI Krithika Iyer (MD) Dennis M. Liston (MD) 1601 N Palm Ave Suite 211 Pembroke Pines, FL 33026 3204 Medicaid No: 000837800 Phone: (888)852 6672 (954)447 0899 TAMIL 2151 E.Commercial Blvd Suite 304 Fort Lauderdale, FL 33308 3807 Medicaid No: 004834600 Phone: (954)492 4525 (954)492 4535 Ronald Kurlander (MD) Ignacio Lopez Merino (MD) 150 E. Sample Road Suite 100 Pompano Beach, FL 33064 3550 Medicaid No: 066282800 Phone: (954)786 2255 (954)786 7146 7050 NW 4 Street Suite 304 Plantation, FL 33317 2247 Medicaid No: 009822900 Phone: (954)791 4774 (954)791 2405 Wednesday, December 09, 2015 Page 22 of 134
Network Alvaro Manotas (MD) Shlomo Pascal (MD) 817 S University Dr, Suite 120 Plantation, FL 33324 3318 Medicaid No: 067467200 Phone: (954)474 9777 (954)474 9744 1711 NW 123 Ave Pembroke Pines, FL 33026 3824 Medicaid No: 005884200 Phone: (954)436 0136 (954)447 9245 ROMANIAN HEBREW Marino Molina (MD) Narendra Patel (MD) 1725 N. University Drive Suite 350 Coral Springs, FL 33071 6000 Medicaid No: 004819000 Phone: (954)227 2700 (954)227 2704 111 North Pine Island Rd Suite 206 Plantation, FL 33324 1836 Medicaid No: 372316000 Phone: (954)791 4300 (954)693 0640 Bhadresh Parikh (MD) Ely Pelta (MD) 7707 North University Drive Suite 207 Tamarac, FL 33321 2966 Medicaid No: 256389400 Phone: (954)721 8118 (954)721 8128 5441 North University Drive Suite 102 Coral Springs, FL 33067 4640 Medicaid No: 011203300 Phone: (954)345 8733 (954)345 8233 YIDDISH PORTUGUESE Wednesday, December 09, 2015 Page 23 of 134
Network Patrick Pinchinat (MD) Carlos Satulovsky (MD) 18503 Pines Blvd Suite 214 Pembroke Pines, FL 33029 1408 Medicaid No: 005590900 Phone: (954)392 6099 (954)392 8366 FRENCH SPANISH CREOLE 300 Diplomat Parkway Apt 301 Hallandale Beach, FL 33009 8721 Medicaid No: 011571300 Phone: (786)376 4011 (954)583 0535 Edward Rosa (MD) Faujia Sobhan (MD) 5451 University Drive Suite 102 Coral Springs, FL 33067 4641 Medicaid No: 252380900 Phone: (954)757 7672 (954)757 7670 7481 W Oakland Park Blvd Suite 100 Lauderhill, FL 33319 4985 Medicaid No: 005591400 Phone: (888)852 6672 (954)771 7748 BENGALI BANGLA Anna Rzadkowolsky Raoli (MD) Tanveer Sobhan (MD) 2699 Stirling RD Suite C 105 Fort Lauderdale, FL 33312 6546 Medicaid No: 004809300 Phone: (954)983 2030 (305)558 6134 7481 W Oakland Park Blvd Suite 100 Lauderhill, FL 33319 4985 Medicaid No: 279204400 Phone: (888)852 6672 (954)771 7748 BENGALI BANGLA Wednesday, December 09, 2015 Page 24 of 134
Network Arun Somani (MD) Florida Palms Academy (SIPP) 9700 Stirling Road Suite 104 Hollywood, FL 33024 8011 Medicaid No: 007166700 Phone: (954)433 2533 (954)433 5575 5925 Mckinley Street Hollywood, FL 33021 4560 Medicaid No: 029582516 Phone: (954)963 0992 Fernando Stern (MD) 3700 Washington Street Suite 304 Hollywood, FL 33021 8258 Medicaid No: 005867200 Phone: (954)961 1500 (954)961 7942 Robert Vassall (MD) 9000 Sheridan Street Suite 110 Pembroke Pines, FL 33024 8805 Medicaid No: 008630500 Phone: (954)447 9938 (954)447 9431 Statewide Inpatient Psychiatric Programs Targeted Case Management Devereux Foundation TCM Dade (TCM) 6365 Taft Street Suite 2002 Hollywood, FL 33024 5973 Medicaid No: 004811800 Phone: (866)440 0613 (866)440 0613 Pickett Fences Family (TCM) 3800 Inverrary Blvd Suite 401 C Lauderhill, FL 33319 4359 Medicaid No: 009156500 Phone: (954)486 8878 (888)516 7046 Wednesday, December 09, 2015 Page 25 of 134
Network Reciprocate 1906 (TCM) Devereux Foundation TFC Broward/Dade (TFC) 3600 S State Road 7 Suite 231 Miramar, FL 33023 5200 Medicaid No: 010730800 Phone: (786)916 3960 (786)916 3961 6365 Taft Street Suite 2002 Hollywood, FL 33024 5973 Medicaid No: 004811800 Phone: (866)440 0613 (866)440 0613 Regional Managment Care Inc (TCM) 3810 Inverrary Blvd Suite 40 A Lauderhill, FL 33319 4356 Medicaid No: 013693000 Phone: (954)473 7373 (954)449 0522 Therapeutic Foster Care/Specialized Therapeutic Devereux Foundation STFC Broward/Dade (STFC) 6365 Taft Street Suite 2002 Hollywood, FL 33024 5973 Medicaid No: 004811800 Phone: (866)440 0613 (866)440 0613 Therapeutic Group Homes Alternate Group Care Inc (TGH) 20250 SW 50TH PLACE Southwest Ranches, FL 33332 1021 Medicaid No: 009183500 Phone: (954)680 8462 (954)252 9960 Alternate Group Care Inc (TGH) 5050 SW 163rd Ave Weston, FL 33331 1434 Medicaid No: 009183500 Phone: (954)252 0227 Wednesday, December 09, 2015 Page 26 of 134
Network County: Calhoun Charlotte Behavioral Health Care (CMHC) Community Mental Health Centers Florida Therapy Services Inc (CMHC) 20859 E Central Ave Blountstown, FL 32424 2263 County: Calhoun Medicaid No: 913786600 Phone: (850)769 6001 (850)769 6003 County: Charlotte Community Mental Health Centers 1700 Education Ave Punta Gorda, FL 33950 3819 County: Charlotte Medicaid No: 060480100 Phone: (941)639 8300 (941)347 6455 Southwest Florida Counseling Center (CMHC) 1777 Tamiami Trail Suite 201 Port Charlotte, FL 33948 1064 County: Charlotte Medicaid No: 009549800 Phone: (941)249 4356 Charlotte Behavioral Health Care (CMHC) County: Citrus 1032 Tamiami Trl Port Charlotte, FL 33953 3802 County: Charlotte Medicaid No: 060480100 Phone: (941)764 7988 (941)639 6381 The Centers Inc (CMHC) 3238 South Lecanto Highway Lecanto, FL 34461 9025 County: Citrus Medicaid No: 060270100 Phone: (352)291 5555 Community Mental Health Centers Psychiatrists Wednesday, December 09, 2015 Page 27 of 134
Network Parmanad Gurnani (MD) Clay Behavioral Health Center Inc (CMHC) 3787 E. Gulf to Lake Hwy Inverness, FL 34453 3204 County: Citrus Medicaid No: 376896100 Phone: (352)726 3950 (352)726 7582 URDU HINDI 3292 County Road 220 Middleburg, FL 32068 4357 County: Clay Medicaid No: 060411902 Phone: (904)291 5561 (904)278 5659 Sonal Parikh (MD) Clay Behavioral Health Center Inc (CMHC) 5596 West Norvell Bryant Hwy Crystal River, FL 34429 7572 County: Citrus Medicaid No: 047147000 Phone: (352)795 6999 89 Knight Boxx Rd Orange Park, FL 32065 8015 County: Clay Medicaid No: 060411902 Phone: (904)213 2909 (904)213 2927 County: Clay Community Mental Health Centers Hospitals/Clinics Orange Park Medical Center (HOSP) Clay Behavioral Health Center Inc (CMHC) 1726 Kingsley Ave Suite 2 Orange Park, FL 32073 4463 County: Clay Medicaid No: 060411902 Phone: (904)278 5644 (904)278 5659 2001 Kingsley Ave Orange Park, FL 32073 5148 County: Clay Medicaid No: 011174100 Phone: (904)276 8500 (904)639 8723 Nurse Practitioner Wednesday, December 09, 2015 Page 28 of 134
Network Paul Zetterower (ARNP) 3292 County Road 220 Middleburg, FL 32068 4357 County: Clay Medicaid No: 768585800 Phone: (904)291 5561 (904)278 5659 Psychiatrists Community Mental Health Centers Collier Health Services Inc. (CMHC) 1265 Creekside Pkwy Suite 208 Naples, FL 34108 1946 County: Collier Medicaid No: 683955001 Phone: (239)591 1755 (239)591 4393 Kathleen Grissett (MD) Collier Health Services Inc. (CMHC) 165 Wells Rd Suite 408 Orange Park, FL 32073 3037 County: Clay Medicaid No: 000665400 Phone: (904)269 7200 1284 Creekside St Suite 101 Naples, FL 34108 1949 County: Collier Medicaid No: 683955001 Phone: (239)596 3133 (239)591 2154 County: Collier Collier Health Services Inc. (CMHC) ABA Facility Every Step Counts Behavioral Therap (ABA) 8344 Laurel Lakes Blvd Naples, FL 34119 9792 County: Collier Medicaid No: NOF Phone: (239)596 2210 (239)877 7734 1441 Heritage Blvd Immokalee, FL 34142 2260 County: Collier Medicaid No: 683955001 Phone: (239)658 3011 (239)658 3070 Wednesday, December 09, 2015 Page 29 of 134
Network Collier Health Services Inc. (CMHC) Collier Health Services Inc. (CMHC) 1454 Madison Ave Immokalee, FL 34142 2067 County: Collier Medicaid No: 683955001 Phone: (239)658 3000 (239)658 3199 3425 10th St N Naples, FL 34103 3866 County: Collier Medicaid No: 683955001 Phone: (239)262 3669 (239)262 2031 Collier Health Services Inc. (CMHC) Collier Health Services Inc. (CMHC) 1755 Heritage Trail Suite A Naples, FL 34112 7600 County: Collier Medicaid No: 683955001 Phone: (239)353 4101 (239)353 4231 508 N 9th St Immokalee, FL 34142 3146 County: Collier Medicaid No: 683955001 Phone: (239)657 6363 (239)657 1612 Collier Health Services Inc. (CMHC) Collier Health Services Inc. (CMHC) 1755 Heritage Trl Suite B Naples, FL 34112 7600 County: Collier Medicaid No: 683955001 Phone: (239)775 2220 (239)775 9363 5262 Golden Gate Pkwy Naples, FL 34116 7635 County: Collier Medicaid No: 683955001 Phone: (239)455 5105 (239)455 7627 Wednesday, December 09, 2015 Page 30 of 134
Network David Lawrence Mental Health Center (CMHC) Family Preservation Services of FL (CMHC) 2806 S Horseshoe Drive Naples, FL 34104 6125 County: Collier Medicaid No: 060288400 Phone: (239)263 4013 (239)643 7278 2675 South Horseshoe Drive Unit 402 Naples, FL 34104 6155 County: Collier Medicaid No: 008760300 Phone: (239)331 8412 (239)963 9152 David Lawrence Mental Health Center (CMHC) Youth Haven Inc (CMHC) 425 North First Street Immokalee, FL 34142 3150 County: Collier Medicaid No: 060288400 Phone: (239)657 4434 (239)657 4331 5867 Whitaker Road Naples, FL 34112 County: Collier Medicaid No: 767828200 Phone: (239)774 2904 (239)774 0801 David Lawrence Mental Health Center (CMHC) 6075 Bathey Lane Naples, FL 34116 7536 County: Collier Medicaid No: 060288400 Phone: (239)455 8500 (239)451 6561 Hospitals/Clinics The Willough at Naples (HOSP) 9001 Tamiami Trail East Naples, FL 34113 3304 County: Collier Medicaid No: 004275200 Phone: (239)775 4500 (239)775 8785 Wednesday, December 09, 2015 Page 31 of 134
Network County: Columbia County: Desoto Community Mental Health Centers Community Mental Health Centers Resolutions Health Alliance PA (CMHC) Charlotte Behavioral Health Care (CMHC) 1344 SE Baya Drive Lake City, FL 32025 4888 County: Columbia Medicaid No: 007889600 Phone: (386)754 9005 (386)754 9017 201 E. Gibson St Arcadia, FL 34266 4707 County: Desoto Medicaid No: 060480100 Phone: (863)494 4200 (863)494 4203 Resolutions Health Alliance PA (CMHC) Family Preservation Services of FL (CMHC) 992 SW Baya Drive Lake City, FL 32025 4209 County: Columbia Medicaid No: 007889600 Phone: (386)754 9005 (386)754 9017 925 North Mills Ave Arcadia, FL 34266 8716 County: Desoto Medicaid No: 008760300 Phone: (941)359 1927 (941)359 1929 Wednesday, December 09, 2015 Page 32 of 134
Network County: Duval Child Guidance Center (CMHC) Community Mental Health Centers Camelot Community Care Inc (CMHC) 4720 Salisbury Rd Suite 127 Jacksonville, FL 32256 6101 County: Duval Medicaid No: 761509400 Phone: (904)493 6160 (850)561 1143 Child Guidance Center (CMHC) 1100 Cesery Blvd Suite 100 Jacksonville, FL 32211 5656 County: Duval Medicaid No: 004823000 Phone: (904)448 4700 (904)448 4717 Child Guidance Center (CMHC) 1110 Edgewood Ave Jacksonville, FL 32254 2326 County: Duval Medicaid No: 004823000 Phone: (904)448 4700 (904)448 4717 4595 Lexington Ave Jacksonville, FL 32210 2058 County: Duval Medicaid No: 004823000 Phone: (904)448 4700 (904)448 4717 Child Guidance Center (CMHC) 5776 ST Augustine Rd Jacksonville, FL 32207 8030 County: Duval Medicaid No: 004823000 Phone: (904)448 4700 (904)448 4717 Childrens Home Society (CMHC) 3027 San Diego Road Jacksonville, FL 32207 3691 County: Duval Medicaid No: 004823200 Phone: (904)493 7744 (904)348 2818 Wednesday, December 09, 2015 Page 33 of 134
Network Gateway Community Services (CMHC) Mental Health Resource Center Inc (CMHC) 555 Stockton Street Jacksonville, FL 33765 3344 County: Duval Medicaid No: 060594800 Phone: (904)387 4661 (904)384 5753 4080 Woodcock Drive Building 2400 Suite 105 Jacksonville, FL 32207 2722 County: Duval Medicaid No: 261464200 Phone: (904)743 1883 (904)743 5109 Mental Health Resource Center Inc (CMHC) Mental Health Resource Center Inc (CMHC) 11820 Beach Blvd Jacksonville, FL 32246 6670 County: Duval Medicaid No: 261464200 Phone: (904)743 1883 (904)743 5109 4427 Emerson Street Building 5 Jacksonville, FL 32207 4960 County: Duval Medicaid No: 261464200 Phone: (904)743 1883 (904)743 5109 Mental Health Resource Center Inc (CMHC) Mental Health Resource Center Inc (CMHC) 3333 West 20th Street Jacksonville, FL 32246 2228 County: Duval Medicaid No: 261464200 Phone: (904)743 1883 (904)743 5109 507 East Curch Sreet Jacksonville, FL 32202 2723 County: Duval Medicaid No: 261464200 Phone: (904)743 1883 (904)743 5109 Wednesday, December 09, 2015 Page 34 of 134
Network Mental Health Resource Center Inc (CMHC) Northwest Behavioral Health Service (CMHC) 655 West 8TH Street Suite 4 South Pavilion Jacksonville, FL 32209 6511 County: Duval Medicaid No: 261464200 Phone: (904)743 1883 (904)743 5109 2392 N Edgewood Ave Jacksonville, FL 32254 1725 County: Duval Medicaid No: 029591401 Phone: (904)781 7797 (908)781 8685 Mental Health Resource Center Inc (CMHC) 921 N. Davis Street Building B Suite 315 Jacksonville, FL 32209 6804 County: Duval Medicaid No: 261464200 Phone: (904)743 1883 (904)743 5109 Northwest Behavioral Health Service (CMHC) 1400 Edgewood Ave Jacksonville, FL 32254 2330 County: Duval Medicaid No: 029591401 Phone: (904)781 7797 (908)781 8685 Hospitals/Clinics Memorial Hospital Jacksonville (HOSP) 3625 University Blvd South Jacksonville, FL 32216 4207 County: Duval Medicaid No: 010193100 Phone: (904)399 6111 (904)399 6849 River Point Behavioral Health (HOSP) 6300 Beach Blvd Jacksonville, FL 32216 2708 County: Duval Medicaid No: 160001000 Phone: (904)724 9202 Wednesday, December 09, 2015 Page 35 of 134
Network Wekiva Springs Hospital (HOSP) Sivanta Paul (MD) 3947 Salisbury Road Jacksonville, FL 32216 6115 County: Duval Medicaid No: 008589300 Phone: (904)296 3533 (904)296 3536 4237 Salisbury Road Suite 301 Jacksonville, FL 32216 0908 County: Duval Medicaid No: 004824500 Phone: (904)279 1666 (904)279 1665 Paul Zetterower (ARNP) 3625 University Blvd S Jacksonville, FL 32216 4207 County: Duval Medicaid No: 768585800 Phone: (904)399 6353 (904)399 6356 Suhas Joshi (MD) 3625 University Blvd S Nurse Practitioner Psychiatrists Jacksonville, FL 32216 4207 County: Duval Medicaid No: 253611100 Phone: (904)399 6353 (904)399 6356 Jorge Richardson (MD) 3625 University Blvd S Jacksonville, FL 32216 4207 County: Duval Medicaid No: 002484700 Phone: (904)399 6353 (904)399 6356 Carlos Torrellas (MD) 4190 Belfort Road Jacksonville, FL 32216 1407 County: Duval Medicaid No: 061534000 Phone: (904)296 2999 (954)296 3623 Wednesday, December 09, 2015 Page 36 of 134
Network Lauren Williams (MD) Childrens Home Society (CMHC) 3625 University Blvd S Jacksonville, FL 32216 4207 County: Duval Medicaid No: 008268100 Phone: (904)399 6353 (904)399 6356 1300 N. Palafox St Suite 103 Pensacola, FL 32501 2678 County: Escambia Medicaid No: 004823200 Phone: (850)266 2700 (850)595 0180 Daniel Memorial Inc (SIPP) 3725 Belfort Road Jacksonville, FL 32216 5813 County: Duval Medicaid No: 004818500 Phone: (904)296 1055 (904)448 7700 Statewide Inpatient Psychiatric Programs Florida Therapy Services Inc (CMHC) 4400 Bayou Blvd Suite 38 Pensacola, FL 32503 1911 County: Escambia Medicaid No: 913786600 Phone: (850)769 6001 (850)769 6003 Hospitals/Clinics County: Escambia West Florida Hospital (HOSP) Community Mental Health Centers Adult & Child Mental Health Care (CMHC) 6706 N 9th Avenue Suite B 5 Pensacola, FL 32504 7378 County: Escambia Medicaid No: 008355300 Phone: (850)466 3200 (850)466 3203 8383 N Davis Highway Pensacola, FL 32514 6039 County: Escambia Medicaid No: Phone: (850)494 4125 (850)494 4382 Nurse Practitioner Wednesday, December 09, 2015 Page 37 of 134
Network Nancy Hart (ARNP) Henry Doelnan (MD) 2191 E. Johnson Avenue Pensacola, FL 32514 6029 County: Escambia Medicaid No: 301818100 Phone: (850)494 3953 (850)494 3960 1120 North Palafox Street Pensacola, FL 32501 2608 County: Escambia Medicaid No: 064497801 Phone: (850)434 5033 (850)433 0268 Stephen Curtis (MD) 2191 E. Johnson Avenue Pensacola, FL 32514 6029 County: Escambia Medicaid No: 271732800 Phone: (850)494 3953 (850)494 3960 Vicence Dillon (MD) 1120 North Palafox Street Pensacola, FL 32501 2608 County: Escambia Medicaid No: 009342800 Phone: (850)434 5033 (850)433 0268 Psychiatrists Julia Fernandez (MD) 2191 E. Johnson Avenue Pensacola, FL 32514 6029 County: Escambia Medicaid No: 009221700 Phone: (850)494 3953 (850)494 3960 John Fetzer (MD) 2191 E. Johnson Avenue Pensacola, FL 32514 6029 County: Escambia Medicaid No: 044224100 Phone: (850)494 3953 (850)494 3960 Wednesday, December 09, 2015 Page 38 of 134
Network David Greenblum (MD) Shabana Jaffri (MD) 2191 E. Johnson Avenue Pensacola, FL 32514 6029 County: Escambia Medicaid No: 068010900 Phone: (850)494 3953 (850)494 3960 2191 E. Johnson Avenue Pensacola, FL 32514 6029 County: Escambia Medicaid No: 000956500 Phone: (850)494 3953 (850)494 3960 John Hayes (MD) Raul Jimenez (MD) 2191 E. Johnson Avenue Pensacola, FL 32514 6029 County: Escambia Medicaid No: 009382500 Phone: (850)494 3953 (850)494 3960 2191 E. Johnson Avenue Pensacola, FL 32514 6029 County: Escambia Medicaid No: 256946900 Phone: (850)494 3953 (850)494 3960 Jian Hu (MD) Timothy Wuerz (DO) 2191 E. Johnson Avenue Pensacola, FL 32514 6029 County: Escambia Medicaid No: 006516900 Phone: (850)494 3953 (850)494 3960 2191 E. Johnson Avenue Pensacola, FL 32514 6029 County: Escambia Medicaid No: 012366000 Phone: (850)494 3953 (850)494 3960 Statewide Inpatient Psychiatric Programs Wednesday, December 09, 2015 Page 39 of 134
Network Lakeview Center Inc (SIPP) SMA Behavioral Health Svcs(OP Svcs) (CMHC) 1221 W Lakeview Ave Pensacola, FL 32501 1857 County: Escambia Medicaid No: 008138500 Phone: (850)432 1222 301 Justice Lane Bunnell, FL 32110 4487 County: Flagler Medicaid No: 004804000 Phone: (386)236 3200 Lakeview Center Inc (SIPP) County: Franklin 1920 North J Street Pensacola, FL 32501 1833 County: Escambia Medicaid No: 008138500 Phone: (850)432 1222 County: Flagler Community Mental Health Centers Coastal Mental Health Center (CMHC) Community Mental Health Centers Apalachee Center Inc. (CMHC) 159 12th Street Apalachicola, FL 32320 2110 County: Franklin Medicaid No: 005112300 Phone: (850)653 9744 Florida Therapy Services Inc (CMHC) 31 Lupi Ct Suite 210 Palm Coast, FL 32137 4762 County: Flagler Medicaid No: 000959600 Phone: (800)614 4124 (888)217 4124 1250 US Hwy 98 Eastpoint, FL 32328 3652 County: Franklin Medicaid No: 913786600 Phone: (850)769 6001 (850)769 6003 Wednesday, December 09, 2015 Page 40 of 134
Network County: Gadsden County: Gulf Community Mental Health Centers Community Mental Health Centers Apalachee Center Inc. (CMHC) Florida Therapy Services Inc (CMHC) 79 LaSalle Path Quincy, FL 32351 5286 County: Gadsden Medicaid No: 005112300 Phone: (850)875 2422 150 Middle School Rd Port St Joe, FL 32456 2261 County: Gulf Medicaid No: 913786600 Phone: (850)769 6001 (850)769 6003 Disc Village Inc. (CMHC) County: Hernando 305B Crawford Street Quincy, FL 32351 3121 County: Gadsden Medicaid No: 762261900 Phone: (850)575 4388 (850)576 3317 Florida Therapy Services Inc (CMHC) 35 Martin Luther King Jr Blvd Quincy, FL 32351 4411 County: Gadsden Medicaid No: 913786600 Phone: (850)769 6001 (850)769 6003 Elizabeth Church (ARNP) Brooksville, FL 34601 8925 Nurse Practitioner 17222 Hospital Blvd. Suite 100 County: Hernando Medicaid No: 010481100 Phone: (352)678 5550 (352)678 5551 Psychiatrists Wednesday, December 09, 2015 Page 41 of 134
Network Hany Botros Mikhail (MD) County: Highlands 12200 Cortez Boulevad Brooksville, FL 34613 2630 County: Hernando Medicaid No: 011199700 Phone: (352)596 4562 (352)596 8188 Tanveer Chaudhry (MD) 17222 Hospital Blvd. Suite 100 Brooksville, FL 34601 8925 County: Hernando Medicaid No: 266168300 Phone: (352)678 5550 (352)678 5551 Shodhan Patel (MD) Community Mental Health Centers Tri County Human Services Inc (CMHC) 100 West College Drive Avon Park, FL 33825 9348 County: Highlands Medicaid No: 060397012 Phone: (863)452 0106 (863)452 5376 County: Hillsborough Community Mental Health Centers Camelot Community Care Inc (CMHC) 12200 Cortez Boulevard Brooksville, FL 34613 2630 County: Hernando Medicaid No: 001210600 Phone: (352)596 4562 (352)596 8188 1412 Tech Blvd Tampa, FL 33619 7865 County: Hillsborough Medicaid No: 761509400 Phone: (813)635 9765 (813)635 9725 Wednesday, December 09, 2015 Page 42 of 134
Network Childrens Home Society (CMHC) Mental Health Care Inc. (CMHC) 1515 Michelin Court Lutz, FL 33549 7533 County: Hillsborough Medicaid No: 004823200 Phone: (813)949 8946 (813)740 4272 2212 A Henry Avenue Tampa, FL 33610 4433 County: Hillsborough Medicaid No: 060272800 Phone: (813)272 2244 (813)233 2745 Family Preservation Services of FL (CMHC) Mental Health Care Inc. (CMHC) 11428 N 53rd Street Tampa, FL 33617 2216 County: Hillsborough Medicaid No: 008760300 Phone: (813)374 9416 (813)443 5795 2212 E Henry Avenue Tampa, FL 33610 4433 County: Hillsborough Medicaid No: 060272800 Phone: (813)272 2244 (813)233 2745 Mental Health Care Inc. (CMHC) Mental Health Care Inc. (CMHC) 1403 W. Reynolds Street Plant City, FL 33563 4325 County: Hillsborough Medicaid No: 060272800 Phone: (813)272 2244 (813)233 2745 2313 W. Violet Street Tampa, FL 33603 1423 County: Hillsborough Medicaid No: 060272800 Phone: (813)272 2244 (813)233 2745 Wednesday, December 09, 2015 Page 43 of 134
Network Mental Health Care Inc. (CMHC) Mental Health Care Inc. (CMHC) 301 N. Palmer Street Plant City, FL 33563 3435 County: Hillsborough Medicaid No: 060272800 Phone: (813)272 2244 (813)233 2745 5802 N. 22nd Street Tampa, FL 33610 4421 County: Hillsborough Medicaid No: 060272800 Phone: (813)272 2244 (813)233 2745 Mental Health Care Inc. (CMHC) Northside Mental Health Center Inc (CMHC) 5707 N. 22nd St Tampa, FL 33610 4350 County: Hillsborough Medicaid No: 060272800 Phone: (813)272 2244 (813)233 2745 12512 Bruce B. Downs Blvd Tampa, FL 33612 9209 County: Hillsborough Medicaid No: 010100500 Phone: (813)977 8700 (813)971 2029 Mental Health Care Inc. (CMHC) Phoenix Houses of Florida (CMHC) 5800 Nebraka Ave Tampa, FL 33604 7128 County: Hillsborough Medicaid No: 060272800 Phone: (813)272 2244 (813)233 2745 510 Vonderburg Drive Suite 301 Brandon, FL 33511 6072 County: Hillsborough Medicaid No: 076716600 Phone: (813)881 1000 (813)689 2684 Wednesday, December 09, 2015 Page 44 of 134
Network Phoenix Houses of Florida (CMHC) Brandon Regional Hospital (HOSP) 5501 W. Waters Avenue Suite 406 Tampa, FL 33634 1229 County: Hillsborough Medicaid No: 076716600 Phone: (813)881 1000 (813)886 2791 119 Oakfield Dr. Brandon, FL 33511 5779 County: Hillsborough Medicaid No: Phone: (813)681 5551 (813)571 5182 The Chrysalis Center (CMHC) Memorial Hospital of Tampa (HOSP) 1228 E 7th Avenue Suite 200 Tampa, FL 33605 3505 County: Hillsborough Medicaid No: 008351800 Phone: (954)587 1008 (954)337 0938 2901 Swann Avenue Tampa, FL 33609 4056 County: Hillsborough Medicaid No: 014549600 Phone: (813)873 6400 (813)342 1423 The Chrysalis Center (CMHC) 6800 N. Dale Mabry Hwy Suite 164 Tampa, FL 33614 3997 County: Hillsborough Medicaid No: 008351800 Phone: (407)295 0123 (954)337 0938 Hospitals/Clinics Kathi Arbigast (ARNP) 221 Hobbs Street Suite 101 Tampa, FL 33619 8068 County: Hillsborough Medicaid No: 307503600 Phone: (813)657 3200 (813)657 8290 Nurse Practitioner Wednesday, December 09, 2015 Page 45 of 134
Network Dorit Breiter (ARNP) Joanna Mulder (ARNP) 4107 W Spruce Street Suite 100 Tampa, FL 33607 2346 County: Hillsborough Medicaid No: 009309700 Phone: (813)636 8811 (813)636 8855 HEBREW 221 Hobbs Street Suite 101 Tampa, FL 33619 8068 County: Hillsborough Medicaid No: 033729300 Phone: (813)657 3200 (813)657 8290 Kimberly Duke (ARNP) 4107 W Spruce Street Suite 100 Tampa, FL 33607 2346 County: Hillsborough Medicaid No: 009310200 Phone: (813)636 8811 (813)636 8855 William Hendrix (ARNP) 221 Hobbs Street Suite 101 Tampa, FL 33619 8068 County: Hillsborough Medicaid No: 014512900 Phone: (813)657 3200 (813)657 8290 Walter Afield (MD) Tampa, FL 33607 2346 Psychiatrists 4107 W Spruce Street Suite 100 County: Hillsborough Medicaid No: 007471300 Phone: (813)636 8811 (813)636 8855 FRENCH ITALIAN Krishan Batra (MD) 16725 Race Track Rd Odessa, FL 33556 3024 County: Hillsborough Medicaid No: 013582400 Phone: (813)926 4700 (813)926 4704 Wednesday, December 09, 2015 Page 46 of 134
Network Suman Bhat (MD) Ashit Vijapura (MD) 613 W. Dr. Martin Luther King Jr. B Suite 101 Tampa, FL 33603 3400 County: Hillsborough Medicaid No: 045959300 Phone: (813)237 1958 (813)237 8147 107 N. Alexander St Plant City, FL 33563 4831 County: Hillsborough Medicaid No: 006258100 Phone: (813)754 1496 (813)754 2553 Adrianus De Ruijter (MD) Ashit Vijapura (MD) 1427 Oakfield Dr. Brandon, FL 33511 2801 County: Hillsborough Medicaid No: 056277700 Phone: (813)685 0500 (813)681 8675 1954 W Dr Martin Luther King Jr Blv Tampa, FL 33607 6510 County: Hillsborough Medicaid No: 006258100 Phone: (813)414 0770 (813)644 7020 Alan Feldman (MD) County: Holmes 2835 W. Delon Street Suite 206 Tampa, FL 33607 1012 County: Hillsborough Medicaid No: 008523900 Phone: (813)871 1123 (727)392 1399 Community Mental Health Centers Florida Therapy Services Inc (CMHC) 701 E Pennsylvania Ave Bonifay, FL 32425 2349 County: Holmes Medicaid No: 913786600 Phone: (850)769 6001 (850)769 6003 Wednesday, December 09, 2015 Page 47 of 134
Network County: Indian River New Horizons of the Treasure Coast (CMHC) Community Mental Health Centers Childrens Home Society (CMHC) 650 10th St Vero Beach, FL 32960 5758 County: Indian River Medicaid No: 004823200 Phone: (772)344 4020 Hibiscus Childrens Center (CMHC) 1145 12 Street Vero Beach, FL 32960 3718 County: Indian River Medicaid No: 004819600 Phone: (772)340 5750 Legacy Behavioral Health Center (CMHC) 755 27th Avenue SW Suite 9 & 10 Vero Beach, FL 32968 4210 County: Indian River Medicaid No: 004805700 Phone: (772)257 5264 (772)257 5265 1910 82nd Avenue Suite 202 Vero Beach, FL 32966 6992 County: Indian River Medicaid No: 004805000 Phone: (772)778 7217 (772)778 7220 Sequelcare of Florida (CMHC) 1910 82nd Avenue Suite 102 Vero Beach, FL 32966 6991 County: Indian River Medicaid No: 008274100 Phone: (772)492 9841 (772)492 9846 Treasure Coast Community Health (CMHC) 12196 County Road Suite 512 Fellsmere, FL 32948 5463 County: Indian River Medicaid No: 013860600 Phone: (772)257 8224 (772)571 1602 Wednesday, December 09, 2015 Page 48 of 134
Network Treasure Coast Community Health (CMHC) Paul Hebig (MD) 1545 Sw 9th Street Vero Beach, FL 32962 4312 County: Indian River Medicaid No: 013860600 Phone: (772)257 8224 (772)571 1602 1000 36 Street Vero Beach, FL 32960 4862 County: Indian River Medicaid No: 009338300 Phone: (772)567 4377 Treasure Coast Community Health (CMHC) Kristin Hicks (MD) 1553 US Highway 1 Suite 105 Vero Beach, FL 32960 4728 County: Indian River Medicaid No: 013860600 Phone: (772)257 8224 (772)571 1602 1190 37th Street Vero Beach, FL 32960 6507 County: Indian River Medicaid No: 006686800 Phone: (772)567 4311 (772)567 4771 Whole Family Health Center Inc (CMHC) Erwin Ramos (MD) 981 37th Place Vero Beach, FL 32960 6541 County: Indian River Medicaid No: 251948800 Phone: (772)468 9900 (772)468 2364 1000 36 Street Vero Beach, FL 32960 4862 County: Indian River Medicaid No: 003746100 Phone: (772)567 4377 Psychiatrists Wednesday, December 09, 2015 Page 49 of 134
Network Erwin Ramos (MD) County: Jefferson 1190 37th Street Vero Beach, FL 32960 6507 County: Indian River Medicaid No: 003746100 Phone: (772)567 4311 (772)567 4771 County: Jackson Community Mental Health Centers Florida Therapy Services Inc (CMHC) Community Mental Health Centers Apalachee Center Inc. (CMHC) 1996 S. Jeffreson St. Monticello, FL 32344 5100 County: Jefferson Medicaid No: 005112300 Phone: (850)997 3958 Florida Therapy Services Inc (CMHC) 2944 Pennsylvania Avenue Suite L Marianna, FL 32448 2741 County: Jackson Medicaid No: 913786600 Phone: (850)769 6001 (850)769 6003 575 S Water St Monticello, FL 32344 1373 County: Jefferson Medicaid No: 913786600 Phone: (850)769 6001 (850)769 6003 Wednesday, December 09, 2015 Page 50 of 134
Network County: Lake Lifestream Behavioral Center (CMHC) Community Mental Health Centers Coastal Mental Health Center (CMHC) 734 North 3rd St Suite 105 Leesburg, FL 34748 5286 County: Lake Medicaid No: 000959600 Phone: (800)614 4124 (888)217 4124 Lifestream Behavioral Center (CMHC) 19826 E. 5th Street Umatilla, FL 32784 3278 County: Lake Medicaid No: 060334100 Phone: (352)771 8996 (352)771 0305 Lifestream Behavioral Center (CMHC) 201 Magnolia Ave Leesburg, FL 34748 5836 County: Lake Medicaid No: 060334100 Phone: (352)351 1550 (352)357 1103 2018 Tally Road Leesburg, FL 34748 3426 County: Lake Medicaid No: 060334100 Phone: (352)315 7400 (352)360 1061 Lifestream Behavioral Center (CMHC) 2020 Tally Road Leesburg, FL 34748 3426 County: Lake Medicaid No: 060334100 Phone: (352)315 7800 (352)360 6610 Lifestream Behavioral Center (CMHC) 215 N. Third Street Leesburg, FL 34748 5105 County: Lake Medicaid No: 060334100 Phone: (352)315 7900 (352)315 3999 Wednesday, December 09, 2015 Page 51 of 134
Network Lifestream Behavioral Center (CMHC) Yasin Choudry (MD) 404 Webster Street Leesburg, FL 34748 5017 County: Lake Medicaid No: 060334100 Phone: (352)360 6625 (352)360 6765 1114 West Dixie Avenue Leesburg, FL 34748 6312 County: Lake Medicaid No: 005805600 Phone: (352)577 8197 URDU Lifestream Behavioral Center (CMHC) 655 Hwy 50 Suite 104 Clermont, FL 34711 2982 County: Lake Medicaid No: 060334100 Phone: (352)394 5922 (352)394 1103 Hospitals/Clinics Statewide Inpatient Psychiatric Programs National Deaf Academy LLC (SIPP) 19650 US HWY 441 Mount Dora, FL 32757 6959 County: Lake Medicaid No: 681196596 Phone: (352)735 9500 (352)735 4939 The Vines Hospital (HOSP) County: Lee 15 La Grande Blvd The Villages, FL 32159 2384 County: Lake Medicaid No: 015006400 Phone: (352)750 3301 (352)750 1632 Psychiatrists ABA Facility Peace by Piece Solutions (ABA) 6714 Winkler Avenue Fort Myers, FL 33919 7204 County: Lee Medicaid No: NOF Phone: (239)245 8301 (239)275 8731 Wednesday, December 09, 2015 Page 52 of 134
Network Community Mental Health Centers Camelot Community Care Inc (CMHC) 5237 Summerlin Commons Blvd Fort Myers, FL 33907 2158 County: Lee Medicaid No: 761509400 Phone: (239)275 2256 (850)561 1143 Childrens Home Society (CMHC) 1940 Maravilla Ave Fort Myers, FL 33901 7135 County: Lee Medicaid No: 004823200 Phone: (239)334 0222 DNA Comprehensive Therapy Services (CMHC) 14180 Metropolis Ave Suite 2 Fort Myers, FL 33912 4449 County: Lee Medicaid No: 014482100 Phone: (239)223 2751 (239)561 2933 Family Preservation Services of FL (CMHC) 2180 Maravilla Ln Fort Myers, FL 33901 7221 County: Lee Medicaid No: 008760300 Phone: (239)332 8009 (239)332 4977 Saluscare Inc. (CMHC) 10140 Deer Run Park Rd Fort Myers, FL 33966 1045 County: Lee Medicaid No: 004805400 Phone: (239)275 3222 (239)332 0287 Saluscare Inc. (CMHC) 1105 Cultural Park Blvd Cape Coral, FL 33990 1217 County: Lee Medicaid No: 004805400 Phone: (239)772 1211 (239)332 0287 Wednesday, December 09, 2015 Page 53 of 134