| Cornerstone Psychiatric Services Inc | |
|
1790 E Venice Ave Suite 204 Venice FL 34292-3191 | |
| (941) 488-8884 | |
| (941) 488-5554 |
| Full Name | Cornerstone Psychiatric Services Inc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1790 E Venice Ave, Venice, Florida |
| Authorized Official Name and Position | Brad Labath (OFFICE MANAGER) |
| Authorized Official Contact | 9414888884 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cornerstone Psychiatric Services Inc 1790 E Venice Ave Suite 204 Venice FL 34292-3191 Ph: (941) 488-8884 | Cornerstone Psychiatric Services Inc 1790 E Venice Ave Suite 204 Venice FL 34292-3191 Ph: (941) 488-8884 |
| NPI Number | 1932195187 |
|---|---|
| Provider Enumeration Date | 09/23/2005 |
| Last Update Date | 09/22/2022 |
| Certification Date | 09/22/2022 |
| Medicare PECOS PAC ID | 8224113584 |
|---|---|
| Medicare Enrollment ID | O20080311000306 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932195187 | NPI | - | NPPES |
| 270064600 | Medicaid | FL | |
| 7384438 | Other | FL | AETNA |
| DA7120 | Other | FL | RAILROAD MEDICARE |
| 557401-000 | Other | FL | MAGELLAN |
| Provider Name | Joan E Flynn |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1639131782 PECOS PAC ID: 2264436153 Enrollment ID: I20060907000363 |
| Provider Name | David Donahue |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1871589028 PECOS PAC ID: 0244317832 Enrollment ID: I20100923001004 |
| Provider Name | David R Fawks |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922094937 PECOS PAC ID: 6507943198 Enrollment ID: I20111103000521 |
| Provider Name | Lenice C Haber |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1770870206 PECOS PAC ID: 6103187331 Enrollment ID: I20180302000604 |
| Provider Name | Nancy J Stetter-coblentz |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1093291833 PECOS PAC ID: 4486904067 Enrollment ID: I20180830003627 |
| Provider Name | Smitha Ajesh |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356940217 PECOS PAC ID: 4587076898 Enrollment ID: I20201210000821 |
| Provider Name | Rebecca P Lindo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083808810 PECOS PAC ID: 1759739709 Enrollment ID: I20231130003546 |
| Provider Name | Kristoffer Villanueva Guerrero |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699554568 PECOS PAC ID: 0042657660 Enrollment ID: I20240319001415 |
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