| Lake Mary Psychiatry And Counseling Llc | |
|
305 Waymont Ct Ste 111 Lake Mary FL 32746-3566 | |
| (407) 324-0405 | |
| (407) 324-0075 |
| Full Name | Lake Mary Psychiatry And Counseling Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 305 Waymont Ct, Lake Mary, Florida |
| Authorized Official Name and Position | Jeffrey Krotenberg (MANAGING MEMBER) |
| Authorized Official Contact | 4073240405 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lake Mary Psychiatry And Counseling Llc Po Box 951468 Lake Mary FL 32795-1468 Ph: (407) 324-0405 | Lake Mary Psychiatry And Counseling Llc 305 Waymont Ct Ste 111 Lake Mary FL 32746-3566 Ph: (407) 324-0405 |
| NPI Number | 1124456587 |
|---|---|
| Provider Enumeration Date | 10/23/2013 |
| Last Update Date | 10/23/2013 |
| Medicare PECOS PAC ID | 6305074022 |
|---|---|
| Medicare Enrollment ID | O20140102000058 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124456587 | NPI | - | NPPES |
| 056251300 | Medicaid | FL | |
| 066470 | Other | VALUE OPTIONS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | OS4985 (Florida) | Primary |
| Provider Name | Jeffrey Al Krotenberg |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1801818703 PECOS PAC ID: 5698808806 Enrollment ID: I20100809000189 |
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