Organization Active NPI

Revamed Center for Emotional Wellbeing, LLC

  • Psychiatry Physician
  • Boca Raton, FL
National Provider Identifier
1093325243
Registry record updated Aug 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
REVAMED CENTER FOR EMOTIONAL WELLBEING, LLC
Practice address
7000 W Palmetto Park Rd Ste 201
Boca Raton, FL 33433-3430
Phone
(561) 391-2770
Fax
(561) 391-2930
NPI assigned
Aug 3, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Melissa Stieler
Title
Credentialing Manager
Phone
(561) 432-2164

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X
Developmental - Behavioral Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2080P0006X
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X Primary
Child & Adolescent Psychiatric/Mental Health Clinical Nurse SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 364SP0807X

Addresses

Primary practice location

7000 W Palmetto Park Rd Ste 201
Boca Raton, FL 33433-3430

Mailing address

8140 Okeechobee Blvd Ste a&B
West Palm Beach, FL 33411-2003
Phone (561) 293-4301

National Provider Directory

National Provider Directory

Locations

7000 W Palmetto Park Rd
Ste 201
Boca Raton, FL 33433
Phone (561) 270-2280

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1596412800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1596412800000",
    "number": "1093325243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8140 OKEECHOBEE BLVD STE A&B",
            "city": "WEST PALM BEACH",
            "state": "FL",
            "postal_code": "334112003",
            "telephone_number": "561-293-4301",
            "fax_number": "561-293-4301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7000 W PALMETTO PARK RD STE 201",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334333430",
            "telephone_number": "561-391-2770",
            "fax_number": "561-391-2930"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVAMED CENTER FOR EMOTIONAL WELLBEING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-03",
        "last_updated": "2020-08-03",
        "certification_date": "2020-08-03",
        "status": "A",
        "authorized_official_last_name": "STIELER",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "561-432-2164"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2080P0006X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics, Developmental - Behavioral Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "364SP0807X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Nurse Specialist, Psychiatric/Mental Health, Child & Adolescent",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boca Raton, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.