Lake Mary Psychiatric Services LLC

Primary specialty

SpecialistTaxonomy code 174400000X

License

ME-82747 Issued in FL

Legal business name

LAKE MARY PSYCHIATRIC SERVICES LLC

Practice address

101 Timberlachen Cir
Suite 201
Lake Mary, FL 32746-6124

Phone

(407) 330-5818

Fax

(407) 330-5820

NPI assigned

Jun 17, 2006

Organization subpart

No

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

Authorized official

Name

Manuel R. Mota-Castillo, M.D.

Title

Psychiatric/Medical Director

Phone

(407) 330-5818

Specialties & licenses 1

Addresses

Other identifiers 6

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

{
    "created_epoch": "1150502400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1285679902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 TIMBERLACHEN CIR",
            "address_2": "SUITE 201",
            "city": "LAKE MARY",
            "state": "FL",
            "postal_code": "327466124",
            "telephone_number": "407-330-5818",
            "fax_number": "407-330-5820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 TIMBERLACHEN CIR",
            "address_2": "SUITE 201",
            "city": "LAKE MARY",
            "state": "FL",
            "postal_code": "327466124",
            "telephone_number": "407-330-5818",
            "fax_number": "407-330-5820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE MARY PSYCHIATRIC SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-17",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MOTA-CASTILLO",
        "authorized_official_first_name": "MANUEL",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "PSYCHIATRIC/MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "407-330-5818",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "FL",
            "license": "ME-82747",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7771009",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MENTAL HEALTH NETWORK",
            "identifier": "111973343307",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HARMONY BEHAVIORAL HEALTH",
            "identifier": "272693",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "52339",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VALUE OPTIONS",
            "identifier": "543580",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIGROUP",
            "identifier": "110962",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Lake Mary, FL
• Providers in Lake Mary, FL by specialty
• Specialist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.