MEDICARE: TREASURE COAST PSYCHIATRIC SERVICES, P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TP0016X	Prescribing (Medical) Psychologist		FL

General Provider Information

NPI Number	:	1083802821
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TREASURE COAST PSYCHIATRIC SERVICES, P.A.

Provider Business Mailing Address
First Line	:	2740 SW MARTIN DOWNS BLVD
Second Line	:	#305
City	:	PALM CITY
State	:	FL
Zip	:	34990-6046
Country	:	US
Telephone Number	:	772-286-8826
Fax Number	:	772-283-5531

Provider Business Practice Location Address
First Line	:	789 S FEDERAL HWY SUITE 213
Second Line	:
City	:	STUART
State	:	FL
Zip	:	34994-2962
Country	:	US
Telephone Number	:	772-286-8826
Fax Number	:	772-283-5531

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	STACEY LOSARDO
Credential	:
Telephone Number	:	772-286-8826

Provider Enumeration Date	:	10/05/2007
Last Update Date	:	11/15/2011

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