Healthcare Provider Details

I. General information

NPI: 1427081819
Provider Name (Legal Business Name): PSYCHIATRIC INTERVENTIONS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 08/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3272 W LAKE MARY BLVD SUITE 1820
LAKE MARY FL
32746-3589
US

IV. Provider business mailing address

3272 W LAKE MARY BLVD SUITE 1820
LAKE MARY FL
32746-3589
US

V. Phone/Fax

Practice location:
  • Phone: 407-330-7393
  • Fax: 407-330-7356
Mailing address:
  • Phone: 407-330-7393
  • Fax: 407-330-7356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License NumberFL58890
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberFL58890
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME58890
License Number StateFL

VIII. Authorized Official

Name: DR. ALAN SAMUEL BERNS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 407-330-7393