| Avatar Cognitive And Behavioral Center, Llc | |
|
7901 4th St N Ste 300 St. Petersburg FL 33702-4399 | |
| (305) 204-3616 | |
| (888) 279-6619 |
| Full Name | Avatar Cognitive And Behavioral Center, Llc |
|---|---|
| Speciality | Psychologist |
| Location | 7901 4th St N Ste 300, St. Petersburg, Florida |
| Authorized Official Name and Position | Lisandra Mendoza (MANAGER) |
| Authorized Official Contact | 3052043616 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Avatar Cognitive And Behavioral Center, Llc 7901 4th St N, Ste 300 St. Petersburg FL 33702 Ph: (305) 204-3616 | Avatar Cognitive And Behavioral Center, Llc 7901 4th St N Ste 300 St. Petersburg FL 33702-4399 Ph: (305) 204-3616 |
| NPI Number | 1558097691 |
|---|---|
| Provider Enumeration Date | 07/30/2022 |
| Last Update Date | 01/22/2025 |
| Certification Date | 01/22/2025 |
| Medicare PECOS PAC ID | 8325576861 |
|---|---|
| Medicare Enrollment ID | O20250110001924 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558097691 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Primary |
| Provider Name | Lisandra Mendoza |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1205408440 PECOS PAC ID: 1951704899 Enrollment ID: I20210729001328 |
| Provider Name | Elizabeth Martin |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1518605476 PECOS PAC ID: 2062939465 Enrollment ID: I20250508003262 |
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