Legacy Behavioral Health Center Inc | |
15818 Sw Warfield Blvd Indiantown FL 34956-3513 | |
(772) 597-0411 | |
(772) 597-0412 |
Full Name | Legacy Behavioral Health Center Inc |
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Speciality | Clinic/Center |
Location | 15818 Sw Warfield Blvd, Indiantown, Florida |
Authorized Official Name and Position | Alicia B. Pajares (PRESIDENT) |
Authorized Official Contact | 5617227866 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Legacy Behavioral Health Center Inc Po Box 458 Indiantown FL 34956-0458 Ph: (772) 597-0411 | Legacy Behavioral Health Center Inc 15818 Sw Warfield Blvd Indiantown FL 34956-3513 Ph: (772) 597-0411 |
NPI Number | 1568439685 |
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Provider Enumeration Date | 03/07/2006 |
Last Update Date | 02/04/2020 |
Certification Date | 02/04/2020 |
Medicare PECOS PAC ID | 3072677756 |
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Medicare Enrollment ID | O20090428000101 |
Identifier | Type | State | Issuer |
---|---|---|---|
1568439685 | NPI | - | NPPES |
600058153 | Other | FL | MAGELLAN HMO |
076140100 | Medicaid | FL |
Provider Name | Oscar D Pozo |
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Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1346238805 PECOS PAC ID: 2365347366 Enrollment ID: I20031203000471 |
Provider Name | Balinder S. Chahal |
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Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1598706442 PECOS PAC ID: 2264337104 Enrollment ID: I20031203000666 |
Provider Name | Francis X Crosby |
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Provider Type | Practitioner - Psychologist Billing Independently |
Provider Identifiers | NPI Number: 1184665804 PECOS PAC ID: 5092615708 Enrollment ID: I20040109000827 |
Provider Name | Alicia B Pajares |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1659357903 PECOS PAC ID: 0749354413 Enrollment ID: I20090428000129 |
Provider Name | Edwin A Gomez |
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Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1780775098 PECOS PAC ID: 4880735406 Enrollment ID: I20100105000354 |
Provider Name | Subhash R Tiwari |
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Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1548217441 PECOS PAC ID: 1355393455 Enrollment ID: I20100217000684 |
Provider Name | Cleopatra Ortiz |
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Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1538373345 PECOS PAC ID: 1355474776 Enrollment ID: I20100804001204 |
Provider Name | Mouville E Caro-gracia |
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Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1003932229 PECOS PAC ID: 5193884872 Enrollment ID: I20110615000471 |
Provider Name | Mehrunnisa Sultana |
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Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1235205410 PECOS PAC ID: 9830367390 Enrollment ID: I20110727000720 |
Provider Name | Myriam Glemaud-garnier |
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Provider Type | Practitioner - Clinical Psychologist |
Provider Identifiers | NPI Number: 1962627950 PECOS PAC ID: 4385660422 Enrollment ID: I20120411000203 |
Provider Name | Jean-baptiste R Jourdan |
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Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1588711683 PECOS PAC ID: 3476714734 Enrollment ID: I20120412000522 |
Provider Name | Leah D Scott |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1376703470 PECOS PAC ID: 7012168495 Enrollment ID: I20121112000447 |
Provider Name | Hope C Atwell |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1225268220 PECOS PAC ID: 6204065683 Enrollment ID: I20140205000862 |
Provider Name | Aimee L Tischuk |
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Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1740344001 PECOS PAC ID: 1254495609 Enrollment ID: I20150227002016 |
Provider Name | Ana Suarez |
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Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1164706404 PECOS PAC ID: 8921317819 Enrollment ID: I20151015001008 |
Provider Name | Juan Luis Castro Cordoba |
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Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1003002106 PECOS PAC ID: 1557412756 Enrollment ID: I20170413000764 |
Provider Name | Mariuxi Katherine Mejia |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1700029618 PECOS PAC ID: 0840551461 Enrollment ID: I20180222001728 |
Provider Name | Phara C Metellus |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1851843403 PECOS PAC ID: 8729349709 Enrollment ID: I20180308001250 |
Provider Name | Margarette Leandre |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1124528427 PECOS PAC ID: 4981036985 Enrollment ID: I20191113000812 |
Provider Name | Barnell Phillips |
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Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1326163775 PECOS PAC ID: 4082796040 Enrollment ID: I20200110001038 |
Provider Name | Margarette Jerome |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1053899179 PECOS PAC ID: 4183052129 Enrollment ID: I20200325001298 |
Provider Name | Magalie Christian |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1770022600 PECOS PAC ID: 4082045117 Enrollment ID: I20200505002783 |
Provider Name | Deborah Nesbit |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1194327692 PECOS PAC ID: 6103238100 Enrollment ID: I20201216001319 |
Provider Name | Laura Reinman |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1053810978 PECOS PAC ID: 7214349109 Enrollment ID: I20201217001958 |
Provider Name | Denise D. Barnes |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1013199306 PECOS PAC ID: 8729394333 Enrollment ID: I20210412001549 |
Provider Name | Sparkle Shandricka Saulter |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1710394150 PECOS PAC ID: 0749680593 Enrollment ID: I20210615003504 |
Provider Name | Mayra L Vargas |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1649755620 PECOS PAC ID: 7618366964 Enrollment ID: I20211108002923 |
Provider Name | Valerie Olga Pullen |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1366783979 PECOS PAC ID: 1759771280 Enrollment ID: I20211124000202 |