Provider Demographics
NPI:1508537093
Name:PSYCHAMERICA BEHAVIORAL SERVICES LLC
Entity Type:Organization
Organization Name:PSYCHAMERICA BEHAVIORAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAX
Authorized Official - Middle Name:
Authorized Official - Last Name:MAGNASCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-902-8331
Mailing Address - Street 1:PO BOX 784719
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34778-4719
Mailing Address - Country:US
Mailing Address - Phone:321-210-8173
Mailing Address - Fax:
Practice Address - Street 1:7065 WESTPOINTE BLVD STE 308
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-8758
Practice Address - Country:US
Practice Address - Phone:800-630-1002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-23
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004589000Medicaid