Healthcare Provider Details

I. General information

NPI: 1932195187
Provider Name (Legal Business Name): CORNERSTONE PSYCHIATRIC SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1790 E VENICE AVE SUITE 204
VENICE FL
34292-3191
US

IV. Provider business mailing address

1790 E VENICE AVE SUITE 204
VENICE FL
34292-3191
US

V. Phone/Fax

Practice location:
  • Phone: 941-488-8884
  • Fax: 941-488-5554
Mailing address:
  • Phone: 941-488-8884
  • Fax: 941-488-5554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberOS8175
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberARNP1799382
License Number StateFL

VIII. Authorized Official

Name: BRAD LABATH
Title or Position: OFFICE MANAGER
Credential:
Phone: 941-488-8884