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General NPI Number Information
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NPI Number | 1245775931
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Entity Type | Organization
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Legal Business Name | SEASIDE PSYCHOLOGICAL SERVICES, LLC
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Dates
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Enumeration Date | 01/04/2017
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Last Update Date | 11/21/2022
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Provider Practice Location Address
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Address Line | 1701 HIGHWAY A1A STE 216
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City | VERO BEACH
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State | FL
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Zip | 32963-2250
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Country | US
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Telephone | 772-925-1121
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Fax | 772-925-1015
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Provider Business Mailing Address
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Address Line | 1701 HIGHWAY A1A STE 216
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City | VERO BEACH
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State | FL
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Zip | 32963-2250
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Country | US
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Telephone | 772-925-1121
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Fax | 772-925-1015
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Authorized Official
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Title or Position | OWNER/PSYCHOLOGIST
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Name | DR. AMY LYNN SOLDERICH
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Credential | PSY.D
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Telephone | 772-925-1121
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | PY 9632
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License Number State | FL
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