| The Beach Therapist Llc | |
|
2792 Peachtree Cir Clearwater FL 33761-3838 | |
| (484) 767-9966 | |
| Not Available |
| Full Name | The Beach Therapist Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 2792 Peachtree Cir, Clearwater, Florida |
| Authorized Official Name and Position | Suzanne Katifedenios (OWNER) |
| Authorized Official Contact | 4847679966 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| The Beach Therapist Llc 2792 Peachtree Cir Clearwater FL 33761-3838 Ph: () - | The Beach Therapist Llc 2792 Peachtree Cir Clearwater FL 33761-3838 Ph: (484) 767-9966 |
| NPI Number | 1063162642 |
|---|---|
| Provider Enumeration Date | 03/25/2022 |
| Last Update Date | 03/25/2022 |
| Certification Date | 03/25/2022 |
| Medicare PECOS PAC ID | 6507252004 |
|---|---|
| Medicare Enrollment ID | O20220411000311 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063162642 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Suzanne Katifedenios |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1760951974 PECOS PAC ID: 0840625265 Enrollment ID: I20220503002617 |
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