Healthcare Provider Details

I. General information

NPI: 1760122287
Provider Name (Legal Business Name): CAREMED CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2022
Last Update Date: 03/31/2022
Certification Date: 03/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4719 HIGHWAY 90
MARIANNA FL
32446-7839
US

IV. Provider business mailing address

PO BOX 14397
POLAND OH
44514-7397
US

V. Phone/Fax

Practice location:
  • Phone: 850-526-3314
  • Fax: 850-526-5022
Mailing address:
  • Phone: 330-758-2775
  • Fax: 330-758-2787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: AMY DEMATTEO
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 330-758-2775