MEDICARE: SEABREEZE BEHAVIORAL MEDICINE PA

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	2084P0800X	Psychiatry Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	38239	OTHER		B/C

General Provider Information

NPI Number	:	1104811272
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEABREEZE BEHAVIORAL MEDICINE PA

Provider Business Mailing Address
First Line	:	3191 HARBOR BLVD STE A
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33952-6755
Country	:	US
Telephone Number	:	941-766-9555
Fax Number	:	941-766-1511

Provider Business Practice Location Address
First Line	:	3191 HARBOR BLVD
Second Line	:	SUITE A
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33952-6755
Country	:	US
Telephone Number	:	941-766-9555
Fax Number	:	941-766-1511

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	BERNARDO J ARIAS
Credential	:	MD
Telephone Number	:	941-766-9555

Provider Enumeration Date	:	09/15/2005
Last Update Date	:	03/08/2012

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Directions to “SEABREEZE BEHAVIORAL MEDICINE PA ” Practice Location

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