| Advanced Behavioral Health Center Pa | |
|
1799 Salk Ave Tavares FL 32778-4311 | |
| (352) 744-8300 | |
| (352) 742-8305 |
| Full Name | Advanced Behavioral Health Center Pa |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1799 Salk Ave, Tavares, Florida |
| Authorized Official Name and Position | Luis Edgardo Torres Rodriguez (PRESIDENT) |
| Authorized Official Contact | 3527428300 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Advanced Behavioral Health Center Pa 1799 Salk Ave Tavares FL 32778-4311 Ph: (352) 744-8300 | Advanced Behavioral Health Center Pa 1799 Salk Ave Tavares FL 32778-4311 Ph: (352) 744-8300 |
| NPI Number | 1043378730 |
|---|---|
| Provider Enumeration Date | 12/05/2006 |
| Last Update Date | 01/30/2008 |
| Medicare PECOS PAC ID | 7315904000 |
|---|---|
| Medicare Enrollment ID | O20041214000938 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043378730 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Luis E Torres |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1568497980 PECOS PAC ID: 6901897669 Enrollment ID: I20040520001305 |
| Provider Name | Hector De Leon |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1821023268 PECOS PAC ID: 4486611183 Enrollment ID: I20041214000988 |
| Provider Name | James S Mcdonough |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1063468700 PECOS PAC ID: 4082672647 Enrollment ID: I20041229000314 |
| Provider Name | Jennifer L Sullivan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1619919594 PECOS PAC ID: 8325363237 Enrollment ID: I20150218000947 |
| Provider Name | Mayra Marimon |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1255721155 PECOS PAC ID: 9234435819 Enrollment ID: I20160308001080 |
| Provider Name | Dennis Lee Cutter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851838536 PECOS PAC ID: 0143506691 Enrollment ID: I20170720002123 |
| Provider Name | David M Getner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073953261 PECOS PAC ID: 7416187513 Enrollment ID: I20200622002625 |
| Provider Name | Tiffany Stephens |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427785120 PECOS PAC ID: 7315322815 Enrollment ID: I20220920001792 |
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