Provider Demographics
NPI:1417193418
Name:JUSTIN A DARIENZO PSYD ABPP PA
Entity Type:Organization
Organization Name:JUSTIN A DARIENZO PSYD ABPP PA
Other - Org Name:PSYCHOLOGICAL FITNESS SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FOUNDER AND CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:D'ARIENZO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, ABPP
Authorized Official - Phone:904-536-5312
Mailing Address - Street 1:11197 TURNBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-2337
Mailing Address - Country:US
Mailing Address - Phone:904-536-5312
Mailing Address - Fax:
Practice Address - Street 1:4651 SALISBURY RD
Practice Address - Street 2:SUITE 532
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-6107
Practice Address - Country:US
Practice Address - Phone:904-536-5312
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-21
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7397103TA0400X, 103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty