Provider Demographics
NPI:1689979874
Name:BIRKMIRE BEHAVIORAL HEALTHCARE, INC
Entity Type:Organization
Organization Name:BIRKMIRE BEHAVIORAL HEALTHCARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE / BILLING SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JESSY
Authorized Official - Middle Name:
Authorized Official - Last Name:LAGOMARSINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-977-7943
Mailing Address - Street 1:650 S CENTRAL AVE
Mailing Address - Street 2:SUITE 4000
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-5900
Mailing Address - Country:US
Mailing Address - Phone:407-977-7943
Mailing Address - Fax:407-977-7944
Practice Address - Street 1:650 S CENTRAL AVE
Practice Address - Street 2:SUITE 4000
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-5900
Practice Address - Country:US
Practice Address - Phone:407-977-7943
Practice Address - Fax:407-977-7944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-19
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME75680103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Single Specialty