Organization Name: | PUTNAM PSYCHOTHERAPY |
NPI Number: | 1114337516 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | CINDY DOREEN SHARPE (OFFICE MANAGER) |
Mailing Address: | 918 Saint Johns Ave Palatka |
State: | FL US |
Postal Code: | 321774650 |
Phone Number: | 3863853887 |
Fax Number: | 3863853922 |
NPI Enumeration Date: | 05/07/2014 |
NPI Last Update Date: | 05/07/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | MH 5246 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |