| Community Behavioral Services | |
|
1543 Kingsley Ave Suite 18a Orange Park FL 32073-4535 | |
| (904) 269-3324 | |
| (904) 264-2302 |
| Full Name | Community Behavioral Services |
|---|---|
| Speciality | Psychologist |
| Location | 1543 Kingsley Ave, Orange Park, Florida |
| Authorized Official Name and Position | Larry Neidigh (CLINICAL DIRECTOR) |
| Authorized Official Contact | 9042693324 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Community Behavioral Services 1543 Kingsley Ave Suite 18a Orange Park FL 32073-4535 Ph: (904) 269-3324 | Community Behavioral Services 1543 Kingsley Ave Suite 18a Orange Park FL 32073-4535 Ph: (904) 269-3324 |
| NPI Number | 1225197544 |
|---|---|
| Provider Enumeration Date | 12/06/2006 |
| Last Update Date | 05/16/2012 |
| Medicare PECOS PAC ID | 1658535695 |
|---|---|
| Medicare Enrollment ID | O20120604000269 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225197544 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | PY4090 (Florida) | Primary |
| Provider Name | Mark S Flynn |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1972657153 PECOS PAC ID: 9436221223 Enrollment ID: I20080711000052 |
| Provider Name | Larry W Neidigh |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1508831322 PECOS PAC ID: 5991969842 Enrollment ID: I20120606000202 |
| Provider Name | April Howell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1588149223 PECOS PAC ID: 5597002444 Enrollment ID: I20190130001831 |
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