Provider Demographics
NPI:1417618893
Name:PRIMARY MDPSYCH LLC
Entity Type:Organization
Organization Name:PRIMARY MDPSYCH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIRYAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ARJONA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:561-420-6419
Mailing Address - Street 1:55 BONNIE DR
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-1858
Mailing Address - Country:US
Mailing Address - Phone:561-420-6419
Mailing Address - Fax:
Practice Address - Street 1:11015 LEGACY LN APT 203
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-3612
Practice Address - Country:US
Practice Address - Phone:561-420-6419
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-06
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care