Provider Demographics
NPI:1568872372
Name:SYSTEMIC INNOVATIONS, LLC
Entity Type:Organization
Organization Name:SYSTEMIC INNOVATIONS, LLC
Other - Org Name:JULIE EBERWEIN PHD, LMHC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:EBERWEIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LMHC, CAP
Authorized Official - Phone:407-691-3960
Mailing Address - Street 1:406 LAKE HOWELL RD
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-5907
Mailing Address - Country:US
Mailing Address - Phone:407-691-3960
Mailing Address - Fax:407-691-3961
Practice Address - Street 1:406 LAKE HOWELL RD
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-5907
Practice Address - Country:US
Practice Address - Phone:407-691-3960
Practice Address - Fax:407-691-3961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-01
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH9903251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001116400Medicaid