Provider Demographics
NPI:1083802821
Name:TREASURE COAST PSYCHIATRIC SERVICES, P.A.
Entity Type:Organization
Organization Name:TREASURE COAST PSYCHIATRIC SERVICES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:LOSARDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-286-8826
Mailing Address - Street 1:2740 SW MARTIN DOWNS BLVD
Mailing Address - Street 2:#305
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-6046
Mailing Address - Country:US
Mailing Address - Phone:772-286-8826
Mailing Address - Fax:772-283-5531
Practice Address - Street 1:789 S FEDERAL HWY SUITE 213
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2962
Practice Address - Country:US
Practice Address - Phone:772-286-8826
Practice Address - Fax:772-283-5531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-05
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK3297Medicare PIN