Provider Demographics
NPI:1821682857
Name:SIESTA ADDICTIONS SPECIALISTS
Entity Type:Organization
Organization Name:SIESTA ADDICTIONS SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:SMITH
Authorized Official - Last Name:BENSON
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:941-343-7244
Mailing Address - Street 1:715 N WASHINGTON BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34236-4256
Mailing Address - Country:US
Mailing Address - Phone:941-343-7244
Mailing Address - Fax:
Practice Address - Street 1:715 N WASHINGTON BLVD STE E
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-4256
Practice Address - Country:US
Practice Address - Phone:941-343-7244
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SIESTA ADDICTIONS SPECIALISTS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-02-20
Last Update Date:2021-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty