Provider Demographics
NPI:1356855639
Name:METAMORPHOSIS PSYCHE LLC
Entity Type:Organization
Organization Name:METAMORPHOSIS PSYCHE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, MGR, DNP
Authorized Official - Prefix:DR
Authorized Official - First Name:CELESTE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, PMHNP-BC, FNP-C
Authorized Official - Phone:954-906-4106
Mailing Address - Street 1:PO BOX 101077
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33310-1077
Mailing Address - Country:US
Mailing Address - Phone:954-906-4106
Mailing Address - Fax:954-906-4029
Practice Address - Street 1:6101 W ATLANTIC BLVD STE 202
Practice Address - Street 2:
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-5157
Practice Address - Country:US
Practice Address - Phone:954-906-4106
Practice Address - Fax:954-906-4029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-26
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9295246261QM0801X
363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL9295246OtherAPRN