Provider Demographics
NPI:1245775931
Name:SEASIDE PSYCHOLOGICAL SERVICES, LLC
Entity Type:Organization
Organization Name:SEASIDE PSYCHOLOGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SOLDERICH
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:772-925-1121
Mailing Address - Street 1:1701 HIGHWAY A1A STE 216
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32963-2250
Mailing Address - Country:US
Mailing Address - Phone:772-925-1121
Mailing Address - Fax:772-925-1015
Practice Address - Street 1:1701 HIGHWAY A1A STE 216
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32963-2250
Practice Address - Country:US
Practice Address - Phone:772-925-1121
Practice Address - Fax:772-925-1015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-04
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 9632251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health