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General NPI Number Information
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NPI Number | 1881276087
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Entity Type | Organization
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Legal Business Name | PSYCH SUPPORT ASSOCIATES LLC
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Dates
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Enumeration Date | 04/27/2021
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Last Update Date | 04/27/2021
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Provider Practice Location Address
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Address Line | 4108 BLUE HOLLOW DR
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City | COLUMBIA
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State | MO
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Zip | 65203-7256
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Country | US
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Telephone | 216-299-2522
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Fax |
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Provider Business Mailing Address
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Address Line | 5915 SW 49TH AVE
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City | OCALA
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State | FL
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Zip | 34474-5701
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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 | CEO
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Name | SWETA DESHMUKH
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Credential |
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Telephone | 216-310-2924
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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