Provider Demographics
NPI:1215185939
Name:E-PSYCHOTHERAPY ASSOCIATES INC
Entity Type:Organization
Organization Name:E-PSYCHOTHERAPY ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:407-977-1435
Mailing Address - Street 1:1939 SUMMER CLUB DR
Mailing Address - Street 2:SUITE 111
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-7121
Mailing Address - Country:US
Mailing Address - Phone:407-977-1435
Mailing Address - Fax:
Practice Address - Street 1:1939 SUMMER CLUB DR
Practice Address - Street 2:SUITE 111
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-7121
Practice Address - Country:US
Practice Address - Phone:407-977-1435
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-06
Last Update Date:2008-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLLCSWSW79151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL767097400Medicaid