Provider Demographics
NPI:1841763844
Name:SIESTA ADDICTIONS SPECIALISTS
Entity Type:Organization
Organization Name:SIESTA ADDICTIONS SPECIALISTS
Other - Org Name:SARASOTA ADDICTION SPECIALISTS
Other - Org Type:Doing Business As
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:LMHC
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?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-02
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use DisorderGroup - Single Specialty