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General NPI Number Information
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NPI Number | 1356133086
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Entity Type | Organization
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Legal Business Name | FORTIS MENTIS PSYCHIATRY, LLC
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Dates
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Enumeration Date | 05/19/2025
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Last Update Date | 05/19/2025
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Provider Practice Location Address
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Address Line | 5038 ASHLEY RIVER RD
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City | WEST PALM BEACH
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State | FL
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Zip | 33417-8352
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Country | US
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Telephone | 561-891-3127
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Fax |
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Provider Business Mailing Address
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Address Line | 5038 ASHLEY RIVER RD
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City | WEST PALM BEACH
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State | FL
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Zip | 33417-8352
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Country | US
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Telephone | 561-891-3127
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KATHLEEN JUDE ESTIME
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Credential | APRN
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Telephone | 561-891-3127
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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