Provider Demographics
NPI:1770222432
Name:PSYCHIATRY & PSYCHOTHERAPY PLLC
Entity Type:Organization
Organization Name:PSYCHIATRY & PSYCHOTHERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JOHANN
Authorized Official - Last Name:PUDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-720-2749
Mailing Address - Street 1:222 W COMSTOCK AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-4272
Mailing Address - Country:US
Mailing Address - Phone:909-720-2749
Mailing Address - Fax:909-255-9752
Practice Address - Street 1:222 W COMSTOCK AVE STE 202
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-4272
Practice Address - Country:US
Practice Address - Phone:909-720-2749
Practice Address - Fax:909-255-9752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty