Provider Demographics
NPI:1003451428
Name:PSYCHOTHERAPY SW FL
Entity Type:Organization
Organization Name:PSYCHOTHERAPY SW FL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRES
Authorized Official - Prefix:
Authorized Official - First Name:EVA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMIDOVA
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:239-247-4231
Mailing Address - Street 1:810 ANCHOR RODE DR
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34103-2739
Mailing Address - Country:US
Mailing Address - Phone:239-247-4231
Mailing Address - Fax:
Practice Address - Street 1:810 ANCHOR RODE DR
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34103-2739
Practice Address - Country:US
Practice Address - Phone:239-247-4231
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-08
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)