| Central Florida Psychotherapy Services Llc | |
|
5302 S Florida Ave Ste 200 Lakeland FL 33813-4922 | |
| (853) 602-7001 | |
| (863) 583-8585 |
| Full Name | Central Florida Psychotherapy Services Llc |
|---|---|
| Speciality | Social Worker |
| Location | 5302 S Florida Ave Ste 200, Lakeland, Florida |
| Authorized Official Name and Position | Jomon Thekkethottiyil (OWNER) |
| Authorized Official Contact | 3304163867 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Central Florida Psychotherapy Services Llc 5302 S Florida Ave Ste 203 Lakeland FL 33813-4910 Ph: (863) 602-7001 | Central Florida Psychotherapy Services Llc 5302 S Florida Ave Ste 200 Lakeland FL 33813-4922 Ph: (853) 602-7001 |
| NPI Number | 1689286809 |
|---|---|
| Provider Enumeration Date | 08/19/2020 |
| Last Update Date | 08/19/2020 |
| Certification Date | 08/19/2020 |
| Medicare PECOS PAC ID | 0446679393 |
|---|---|
| Medicare Enrollment ID | O20200928000985 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689286809 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Jomon Thekkethottiyil |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1023376894 PECOS PAC ID: 8022253897 Enrollment ID: I20130327000146 |
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