Provider Demographics
NPI:1083487201
Name:FLORIDA CENTER FOR PSYCHIATRIC SERVICES, PLLC
Entity Type:Organization
Organization Name:FLORIDA CENTER FOR PSYCHIATRIC SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF NEW PROGRAM DEVELOPMENT OFFIC
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TAVERNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-531-1528
Mailing Address - Street 1:13800 TECH CITY CIR STE 322
Mailing Address - Street 2:
Mailing Address - City:ALACHUA
Mailing Address - State:FL
Mailing Address - Zip Code:32615-7254
Mailing Address - Country:US
Mailing Address - Phone:425-531-1528
Mailing Address - Fax:
Practice Address - Street 1:4600 LINTON BLVD STE 250
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-6600
Practice Address - Country:US
Practice Address - Phone:425-531-1528
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-31
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health