Provider Demographics
NPI:1093025702
Name:PSYCHAMERICA BEHAVIORAL SERVICES LLC
Entity Type:Organization
Organization Name:PSYCHAMERICA BEHAVIORAL SERVICES LLC
Other - Org Name:BIG BEAR BEHAVIORAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAX
Authorized Official - Middle Name:
Authorized Official - Last Name:MAGNASCO
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:800-840-2528
Mailing Address - Street 1:PO BOX 784719
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34778-4719
Mailing Address - Country:US
Mailing Address - Phone:800-840-2528
Mailing Address - Fax:407-540-9552
Practice Address - Street 1:7065 WESTPOINTE BLVD STE 308
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-8758
Practice Address - Country:US
Practice Address - Phone:800-840-2528
Practice Address - Fax:407-540-9552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-15
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 103TP2701X, 251B00000X, 261QM0801X
FLL10000019130251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Single Specialty
No251B00000XAgenciesCase Management
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002803500Medicaid
FL014778600Medicaid
FL0045890-00Medicaid
FL014148500Medicaid