Provider Demographics
NPI:1396834024
Name:STARFISH PSYCHIATRIC SERVICES PL
Entity Type:Organization
Organization Name:STARFISH PSYCHIATRIC SERVICES PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHARINA
Authorized Official - Middle Name:E
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-243-7035
Mailing Address - Street 1:PO BOX 879
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32549-0879
Mailing Address - Country:US
Mailing Address - Phone:850-243-7035
Mailing Address - Fax:850-243-8529
Practice Address - Street 1:68 BEAL PKWY SW
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32548-5331
Practice Address - Country:US
Practice Address - Phone:850-243-7035
Practice Address - Fax:850-243-8529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 88592084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL71705OtherBCBS PROVIDER NUMBER
FLH57443Medicare UPIN