Provider Demographics
NPI:1104148758
Name:FL KEYS INTENSIVE OUTPATIENT PROGRAM, LLC
Entity type:Organization
Organization Name:FL KEYS INTENSIVE OUTPATIENT PROGRAM, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:E
Authorized Official - Last Name:O'LEAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-294-9554
Mailing Address - Street 1:1111 12TH ST
Mailing Address - Street 2:SUITE 413
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-4088
Mailing Address - Country:US
Mailing Address - Phone:305-294-9554
Mailing Address - Fax:305-294-1316
Practice Address - Street 1:1111 12TH ST
Practice Address - Street 2:SUITE 413
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-4088
Practice Address - Country:US
Practice Address - Phone:305-294-9554
Practice Address - Fax:305-294-1316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-24
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME883612084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty