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NPI Code Detail

MEDICARE: CENTER FOR MOOD DISORDERS LLC

MEDICARE: CENTER FOR MOOD DISORDERS LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251S00000XCommunity/Behavioral Health AgencyLM12574FL

General Provider Information

NPI Number : 1033521026
Entity Type Code : Organization
Provider Name (Legal Business Name) : CENTER FOR MOOD DISORDERS LLC
Provider Business Mailing Address
First Line : 1408 19TH ST
Second Line : SUITE C
City : VERO BEACH
State : FL
Zip : 32960-3628
Country : US
Telephone Number : 772-224-1294
Fax Number :
Provider Business Practice Location Address
First Line : 1408 19TH ST
Second Line : SUITE C
City : VERO BEACH
State : FL
Zip : 32960-3628
Country : US
Telephone Number : 772-224-1294
Fax Number :
Authorized Official
Title or Position : OWNER
Name : JODI L OLMSTEAD
Credential : LMHC
Telephone Number : 772-224-1294
Provider Enumeration Date : 05/24/2014
Last Update Date : 05/24/2014

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Directions to “CENTER FOR MOOD DISORDERS LLC ” Practice Location

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