Provider Demographics
NPI:1790519270
Name:MONARCH ACADEMY FOR NEURODIVERGENT YOUTH AND YOUNG ADULTS L.L.C.
Entity type:Organization
Organization Name:MONARCH ACADEMY FOR NEURODIVERGENT YOUTH AND YOUNG ADULTS L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:POSTDOCTORAL CLINICAL PSYCH FELLOW
Authorized Official - Prefix:DR
Authorized Official - First Name:AMARIS
Authorized Official - Middle Name:
Authorized Official - Last Name:AVELLAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:949-232-0513
Mailing Address - Street 1:3948 3RD ST S # 121
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-5847
Mailing Address - Country:US
Mailing Address - Phone:949-232-0513
Mailing Address - Fax:
Practice Address - Street 1:5422 FIRST COAST HWY STE 102
Practice Address - Street 2:
Practice Address - City:AMELIA ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32034-5403
Practice Address - Country:US
Practice Address - Phone:949-232-0513
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No177F00000XOther Service ProvidersLodgingGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No174200000XOther Service ProvidersMeals
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251S00000XAgenciesCommunity/Behavioral Health
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No253Z00000XAgenciesIn Home Supportive Care
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No385H00000XRespite Care FacilityRespite Care
No385HR2050XRespite Care FacilityRespite CareRespite Care Camp
No385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child