1215546916 NPI number — LET'S TALK PSYCHOTHERAPY P.A.

Table of content: (NPI 1215546916)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215546916 NPI number — LET'S TALK PSYCHOTHERAPY P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LET'S TALK PSYCHOTHERAPY P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215546916
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/02/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1275 HIGHWAY 1
Provider Second Line Business Mailing Address:
SUITE 2 - 6031
Provider Business Mailing Address City Name:
VERO BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32960-4706
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-899-1034
Provider Business Mailing Address Fax Number:
772-778-4246

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1275 US HIGHWAY 1
Provider Second Line Business Practice Location Address:
SUITE 2 - 6031
Provider Business Practice Location Address City Name:
VERO BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32960-4760
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-899-1934
Provider Business Practice Location Address Fax Number:
772-778-4706
Provider Enumeration Date:
07/28/2020

Additional Information

Authorized Official

Authorized Official Last Name:
TORREZ
Authorized Official First Name:
LEANA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
772-202-0517

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: MH17081 . This is a "LICENSURE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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