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NPI Code Detail

MEDICARE: ONE STOP PSYCHIATRY LLC

MEDICARE: ONE STOP PSYCHIATRY 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
11041C0700XClinical Social Worker
2363LP0808XPsychiatric/Mental Health Nurse Practitioner

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1952056780
Entity Type Code : Organization
Provider Name (Legal Business Name) : ONE STOP PSYCHIATRY LLC
Provider Business Mailing Address
First Line : 3015 N OCEAN BLVD STE C101
Second Line :
City : FORT LAUDERDALE
State : FL
Zip : 33308-7300
Country : US
Telephone Number : 754-270-6322
Fax Number : 754-270-6321
Provider Business Practice Location Address
First Line : 3015 N OCEAN BLVD STE C101
Second Line :
City : FORT LAUDERDALE
State : FL
Zip : 33308-7300
Country : US
Telephone Number : 754-270-6322
Fax Number : 754-270-6321
Authorized Official
Title or Position : PRACTICE DEVELOPMENT CONSULTANT
Name : JERJUAN TOLES
Credential : BSHSM, MSHA
Telephone Number : 239-595-9040
Provider Enumeration Date : 02/21/2022
Last Update Date : 05/21/2026

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Directions to “ONE STOP PSYCHIATRY LLC ” Practice Location

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