Provider Demographics
NPI:1558097691
Name:AVATAR COGNITIVE AND BEHAVIORAL CENTER, LLC
Entity Type:Organization
Organization Name:AVATAR COGNITIVE AND BEHAVIORAL CENTER, LLC
Other - Org Name:AVATAR CBC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:LISANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDOZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-204-3616
Mailing Address - Street 1:7901 4TH ST N, STE 300
Mailing Address - Street 2:
Mailing Address - City:ST. PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702
Mailing Address - Country:US
Mailing Address - Phone:305-204-3616
Mailing Address - Fax:888-279-6619
Practice Address - Street 1:7901 4TH ST N STE 300
Practice Address - Street 2:
Practice Address - City:ST. PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-4399
Practice Address - Country:US
Practice Address - Phone:305-204-3616
Practice Address - Fax:888-279-6619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-30
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty