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General NPI Number Information
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NPI Number | 1548534456
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Entity Type | Organization
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Legal Business Name | PSYCHOLOGICAL TRAUMA MANAGEMENT SERVICES
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Dates
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Enumeration Date | 02/24/2012
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Last Update Date | 02/24/2012
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Provider Practice Location Address
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Address Line | 111 E MONUMENT AVE SUITE 330
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City | KISSIMMEE
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State | FL
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Zip | 34741-5762
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Country | US
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Telephone | 407-460-0418
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Fax |
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Provider Business Mailing Address
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Address Line | 111 E MONUMENT AVE SUITE 330
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City | KISSIMMEE
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State | FL
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Zip | 34741-5762
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SUPERVISOR
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Name | DR. ROBERT W. STEWART
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Credential | LCSW
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Telephone | 407-460-0418
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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