MEDICARE: PSYCHOTHERAPEUTIC SERVICES OF FLORIDA, IN

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	104100000X	Social Worker
2	103TC1900X	Counseling Psychologist
3	163W00000X	Registered Nurse
4	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

General Provider Information

NPI Number	:	1508432295
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PSYCHOTHERAPEUTIC SERVICES OF FLORIDA, IN

Provider Business Mailing Address
First Line	:	870 HIGH ST STE 2
Second Line	:
City	:	CHESTERTOWN
State	:	MD
Zip	:	21620-3914
Country	:	US
Telephone Number	:	410-788-1099
Fax Number	:

Provider Business Practice Location Address
First Line	:	4152 OKEECHOBEE RD STE C
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34947-5402
Country	:	US
Telephone Number	:	772-467-3097
Fax Number	:

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	RANDALL COOPER
Credential	:
Telephone Number	:	410-810-2468

Provider Enumeration Date	:	06/02/2021
Last Update Date	:	06/10/2021

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