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NPI Code Detail

MEDICARE: PSYCHOLOGICAL CARE SERVICES OF FL, LLC

MEDICARE: PSYCHOLOGICAL CARE SERVICES OF FL, 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
11041C0700XClinical Social Worker
2103TC0700XClinical Psychologist

General Provider Information

NPI Number : 1881960474
Entity Type Code : Organization
Provider Name (Legal Business Name) : PSYCHOLOGICAL CARE SERVICES OF FL, LLC
Provider Business Mailing Address
First Line : 109 DOUBLOON DR
Second Line :
City : SLIDELL
State : LA
Zip : 70461-2715
Country : US
Telephone Number : 985-641-2513
Fax Number : 985-265-4155
Provider Business Practice Location Address
First Line : 495 GRAND BLVD
Second Line : STE 206
City : MIRAMAR BEACH
State : FL
Zip : 32550-1897
Country : US
Telephone Number : 985-641-2513
Fax Number : 985-265-4155
Authorized Official
Title or Position : SOLE MBR
Name : GERTRUDE M PARKER
Credential :
Telephone Number : 985-641-2513
Provider Enumeration Date : 03/28/2012
Last Update Date : 08/21/2013

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