=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538507041
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EMPATHIC PSYCHIATRY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/06/2013
-----------------------------------------------------
Last Update Date | 06/06/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1408 N KILLIAN DR SUITE 201
-----------------------------------------------------
City | LAKE PARK
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33403-1962
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-845-9488
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1408 N KILLIAN DR SUITE 201
-----------------------------------------------------
City | LAKE PARK
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33403-1962
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-845-9488
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MBR
-----------------------------------------------------
Name | MR. NOEL NEU
-----------------------------------------------------
Credential | MS, LMHC
-----------------------------------------------------
Telephone | 561-845-9488
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | MH8954
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------