Provider Demographics
NPI:1801227129
Name:PSYCHOTHERAPY AND CONSULTATION ASSOCIATES, LLC
Entity Type:Organization
Organization Name:PSYCHOTHERAPY AND CONSULTATION ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:I
Authorized Official - Last Name:VERA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:352-275-8871
Mailing Address - Street 1:PO BOX 357264
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32635-7264
Mailing Address - Country:US
Mailing Address - Phone:352-275-8871
Mailing Address - Fax:904-212-2129
Practice Address - Street 1:1605 NW 16TH AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4037
Practice Address - Country:US
Practice Address - Phone:352-275-8871
Practice Address - Fax:904-212-2129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-12
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 12731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty