Lake Mary Psychiatry and Counseling LLC

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

OS4985 Issued in FL

Legal business name

LAKE MARY PSYCHIATRY AND COUNSELING LLC

Practice address

305 Waymont CT
Ste 111
Lake Mary, FL 32746-3566

Phone

(407) 324-0405

Fax

(407) 324-0075

NPI assigned

Oct 23, 2013

Organization subpart

No

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

Authorized official

Name

Jeffrey Krotenberg, D.O.

Title

Managing Member

Phone

(407) 324-0405

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

Practitioners 1

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

• Marilyn Hart Fair, LMHC, MAC, CFM

  • Addiction (Substance Use Disorder) Counselor
  • Lake Mary, FL
  • NPI 1245395854
  NPD (past)

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

{
    "created_epoch": "1382486400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1382486400000",
    "number": "1124456587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 951468",
            "city": "LAKE MARY",
            "state": "FL",
            "postal_code": "327951468",
            "telephone_number": "407-324-0405",
            "fax_number": "407-324-0075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 WAYMONT CT",
            "address_2": "STE 111",
            "city": "LAKE MARY",
            "state": "FL",
            "postal_code": "327463566",
            "telephone_number": "407-324-0405",
            "fax_number": "407-324-0075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE MARY PSYCHIATRY AND COUNSELING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-23",
        "last_updated": "2013-10-23",
        "status": "A",
        "authorized_official_last_name": "KROTENBERG",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "407-324-0405",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "FL",
            "license": "OS4985",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "056251300",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VALUE OPTIONS",
            "identifier": "066470",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lake Mary Medical Services, LLC
• Lake Mary Modern Dentistry, PA
• Lake Mary OB/GYN
• Lake Mary Plastic and Cosmetic Surgery PA
• Lake Mary Psychiatric Services LLC
• Lake Mary Radiology, PLLC
• Lake Mary Smiles, PLLC
• Lake Mary Surgery Center LLC
• Lake Mary Walk-in Medical Center
• Briana Lake

• Psychiatry Physician in Lake Mary, FL
• Providers in Lake Mary, FL by specialty
• Psychiatry Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2013; 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.