| Deep River Psychological Services Llc | |
|
323 10th Ave W Suite 302 Palmetto FL 34221-5047 | |
| (941) 721-6325 | |
| (941) 723-6741 |
| Full Name | Deep River Psychological Services Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 323 10th Ave W, Palmetto, Florida |
| Authorized Official Name and Position | Jennifer H Mendoza (OWNER/PSYCHOLOGIST) |
| Authorized Official Contact | 9417216325 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Deep River Psychological Services Llc 323 10th Ave W Suite 302 Palmetto FL 34221-5047 Ph: (941) 721-6325 | Deep River Psychological Services Llc 323 10th Ave W Suite 302 Palmetto FL 34221-5047 Ph: (941) 721-6325 |
| NPI Number | 1386086726 |
|---|---|
| Provider Enumeration Date | 07/26/2013 |
| Last Update Date | 08/15/2013 |
| Medicare PECOS PAC ID | 9739322546 |
|---|---|
| Medicare Enrollment ID | O20130827000244 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386086726 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | PY5572 (Florida) | Primary |
| Provider Name | Jennifer H Mendoza |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1083602544 PECOS PAC ID: 1355345117 Enrollment ID: I20060908000414 |
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