Healthcare Provider Details

I. General information

NPI: 1841678141
Provider Name (Legal Business Name): PSYCHIATRIC SPECIALTY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2015
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 S STATE ROAD 7 STE 209
WELLINGTON FL
33414-6136
US

IV. Provider business mailing address

1035 S STATE ROAD 7 STE 209
WELLINGTON FL
33414-6136
US

V. Phone/Fax

Practice location:
  • Phone: 615-331-8800
  • Fax: 561-331-8074
Mailing address:
  • Phone: 561-331-8800
  • Fax: 561-331-8074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME113557
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberME96194
License Number StateFL

VIII. Authorized Official

Name: AMANDA ENID PUSEY
Title or Position: OWNER
Credential: M.D.
Phone: 561-331-8800