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NPI Code Detail

MEDICARE: PSYWELL, LLC

MEDICARE: PSYWELL, LLC
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
1101YM0800XMental Health Counselor
2103TC0700XClinical Psychologist

General Provider Information

NPI Number : 1386289601
Entity Type Code : Organization
Provider Name (Legal Business Name) : PSYWELL, LLC
Provider Business Mailing Address
First Line : 6803 LAKE WORTH RD STE 215
Second Line :
City : GREENACRES
State : FL
Zip : 33467-2979
Country : US
Telephone Number : 561-207-7625
Fax Number :
Provider Business Practice Location Address
First Line : 6803 LAKE WORTH RD STE 215
Second Line :
City : GREENACRES
State : FL
Zip : 33467-2979
Country : US
Telephone Number : 561-207-7625
Fax Number :
Authorized Official
Title or Position : PSYCHOLOGIST
Name : DR. PAULA SHAW
Credential : PSYD
Telephone Number : 561-207-7625
Provider Enumeration Date : 11/11/2019
Last Update Date : 01/06/2026

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