Provider Demographics
NPI:1073763470
Name:SEBRING PSYCH MED INC
Entity Type:Organization
Organization Name:SEBRING PSYCH MED INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GERARDO
Authorized Official - Middle Name:F
Authorized Official - Last Name:OLIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:863-452-1325
Mailing Address - Street 1:1753 US 27 N
Mailing Address - Street 2:
Mailing Address - City:AVON PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33825-9504
Mailing Address - Country:US
Mailing Address - Phone:863-452-1325
Mailing Address - Fax:863-452-1385
Practice Address - Street 1:1753 US 27 N
Practice Address - Street 2:
Practice Address - City:AVON PARK
Practice Address - State:FL
Practice Address - Zip Code:33825-9504
Practice Address - Country:US
Practice Address - Phone:863-452-1325
Practice Address - Fax:863-452-1385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-23
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL643642251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health