Healthcare Provider Details

I. General information

NPI: 1003821497
Provider Name (Legal Business Name): YORKSHIRE MENTAL HEALTH ENTERPRISES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 10/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 W GRANADA BLVD SUITE 2E
ORMOND BEACH FL
32174-5190
US

IV. Provider business mailing address

595 W GRANADA BLVD SUITE 2E
ORMOND BEACH FL
32174-5190
US

V. Phone/Fax

Practice location:
  • Phone: 386-672-4222
  • Fax: 386-672-8855
Mailing address:
  • Phone: 386-672-4222
  • Fax: 386-672-8855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: LOUIS J RAIMONDO
Title or Position: MANAGER
Credential: MD
Phone: 386-672-4222