Provider Demographics
NPI:1609030899
Name:PSYCHIATRIC CENTER OF FLORIDA
Entity Type:Organization
Organization Name:PSYCHIATRIC CENTER OF FLORIDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:KEEFER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-939-2205
Mailing Address - Street 1:12641 WORLD PLAZA LN
Mailing Address - Street 2:SUITE 56
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-3990
Mailing Address - Country:US
Mailing Address - Phone:239-939-2205
Mailing Address - Fax:239-939-4662
Practice Address - Street 1:12641 WORLD PLAZA LN
Practice Address - Street 2:SUITE 56
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-3990
Practice Address - Country:US
Practice Address - Phone:239-939-2205
Practice Address - Fax:239-939-4662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME058989103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamilyGroup - Multi-Specialty