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General NPI Number Information
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NPI Number | 1972788669
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Entity Type | Organization
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Legal Business Name | HARBORSIDE PSYCHIATRIC SERVICES, LLC
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Dates
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Enumeration Date | 01/01/2008
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Last Update Date | 05/17/2018
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Provider Practice Location Address
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Address Line | 150 W. MCKENZIE STREET SUITE #117
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City | PUNTA GORDA
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State | FL
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Zip | 33950
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Country | US
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Telephone | 941-205-3333
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Fax | 941-205-3334
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Provider Business Mailing Address
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Address Line | 150 W. MCKENZIE STREET SUITE #117
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City | PUNTA GORDA
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State | FL
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Zip | 33950-5500
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Country | US
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Telephone | 941-205-3333
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Fax | 941-205-3334
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Authorized Official
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Title or Position | PARTNER
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Name | MS. JOAN E. FLYNN
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Credential | LCSW
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Telephone | 941-205-3333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW7783
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | L07000124924
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | ME86547
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | L07000124924
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License Number State | FL
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