Provider Demographics
NPI:1740620525
Name:FOUR SEASONS PSYCHOLOGICAL SERVICES INC
Entity type:Organization
Organization Name:FOUR SEASONS PSYCHOLOGICAL SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SOREN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:BARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:772-538-4656
Mailing Address - Street 1:3625 EAGLE DR
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32963-1650
Mailing Address - Country:US
Mailing Address - Phone:772-538-1038
Mailing Address - Fax:
Practice Address - Street 1:777 37TH ST
Practice Address - Street 2:SUITE B107
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-4873
Practice Address - Country:US
Practice Address - Phone:772-538-1038
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-26
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY4688103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE0102Medicare UPIN