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General NPI Number Information
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NPI Number | 1114817004
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Entity Type | Organization
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Legal Business Name | VIRTUAL PSYCHIATRY LLC
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Dates
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Enumeration Date | 07/03/2025
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Last Update Date | 07/03/2025
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Provider Practice Location Address
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Address Line | 9 PAULINE STREET
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City | BROCKTON
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State | MA
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Zip | 02302
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Country | US
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Telephone | 774-344-5914
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Fax | 508-213-3628
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Provider Business Mailing Address
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Address Line | 9 PAULINE ST
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City | BROCKTON
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State | MA
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Zip | 02302-3800
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Country | US
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Telephone | 774-240-5585
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Fax | 508-213-3628
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Authorized Official
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Title or Position | PMHNP
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Name | MRS. LIUDMILA CARDOSO
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Credential | APRN
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Telephone | 774-240-5585
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number |
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License Number State |
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