Provider Demographics
NPI:1780864223
Name:CENTER FOR PSYCHOLOGICAL SERVICES INC
Entity Type:Organization
Organization Name:CENTER FOR PSYCHOLOGICAL SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:ROCKY
Authorized Official - Last Name:D'AMATO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:904-269-6677
Mailing Address - Street 1:PO BOX 1556
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32067-1556
Mailing Address - Country:US
Mailing Address - Phone:904-269-6677
Mailing Address - Fax:904-269-6677
Practice Address - Street 1:4256 WICKS BRANCH RD
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5568
Practice Address - Country:US
Practice Address - Phone:904-269-6677
Practice Address - Fax:904-269-6677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY3352103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK5734Medicare PIN