Healthcare Provider Details

I. General information

NPI: 1235331380
Provider Name (Legal Business Name): CENTER FOR ADULT PSYCHIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 09/24/2020
Certification Date: 09/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 CITRUS MEDICAL CT
OCOEE FL
34761-4547
US

IV. Provider business mailing address

7512 DR PHILLIPS BLVD STE # 50 PMB #514
ORLANDO FL
32819-5131
US

V. Phone/Fax

Practice location:
  • Phone: 407-245-8501
  • Fax: 407-245-8503
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License NumberME75492
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: SURABHI SINGH
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 407-602-7168