Healthcare Provider Details

I. General information

NPI: 1083802821
Provider Name (Legal Business Name): TREASURE COAST PSYCHIATRIC SERVICES, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2007
Last Update Date: 11/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

789 S FEDERAL HWY SUITE 213
STUART FL
34994-2962
US

IV. Provider business mailing address

2740 SW MARTIN DOWNS BLVD #305
PALM CITY FL
34990-6046
US

V. Phone/Fax

Practice location:
  • Phone: 772-286-8826
  • Fax: 772-283-5531
Mailing address:
  • Phone: 772-286-8826
  • Fax: 772-283-5531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number
License Number StateFL

VIII. Authorized Official

Name: STACEY LOSARDO
Title or Position: VICE PRESIDENT
Credential:
Phone: 772-286-8826