NPIMap

Organization Active NPI

Brightside Psychology & Internal Medicine LLC

  • Clinical Psychologist
  • Orlando, FL
National Provider Identifier
1376846584
Registry record updated Feb 3, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PY7638 Issued in FL
Legal business name
BRIGHTSIDE PSYCHOLOGY & INTERNAL MEDICINE LLC
Practice address
1277 N Semoran Blvd
Suite 107
Orlando, FL 32807-3569
Phone
(407) 601-7748
Fax
(407) 601-7749
NPI assigned
Dec 9, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 3, 2012

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

Authorized official

Name
Dr. Kamir Marrero, PSYDNPI 1275718819
Title
President
Phone
(407) 601-7748

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X MH10506 FL
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X PY7638 FL Primary
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X PY7723 FL
Counseling PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC1900X PY8298 FL
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X ME110882 FL

Addresses

Primary practice location

1277 N Semoran Blvd
Suite 107
Orlando, FL 32807-3569

Mailing address

1277 N Semoran Blvd
Suite 107
Orlando, FL 32807-3569
Phone (407) 601-7748

National Provider Directory

National Provider Directory

Locations

1277 N Semoran Blvd
Ste 107
Orlando, FL 32807
Phone (407) 601-7748

1417 N Semoran Blvd
Ste 202
Orlando, FL 32807
Phone (407) 601-7748

Practitioners & affiliated clinicians

Practitioners 4

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": "1291852800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1328227200000",
    "number": "1376846584",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1277 N SEMORAN BLVD",
            "address_2": "SUITE 107",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328073569",
            "telephone_number": "407-601-7748",
            "fax_number": "407-601-7749"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1277 N SEMORAN BLVD",
            "address_2": "SUITE 107",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328073569",
            "telephone_number": "407-601-7748",
            "fax_number": "407-601-7749"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRIGHTSIDE PSYCHOLOGY & INTERNAL MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-09",
        "last_updated": "2012-02-03",
        "status": "A",
        "authorized_official_last_name": "MARRERO",
        "authorized_official_first_name": "KAMIR",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "407-601-7748",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH10506",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "FL",
            "license": "PY7638",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "FL",
            "license": "PY7723",
            "primary": false
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Counseling",
            "state": "FL",
            "license": "PY8298",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "FL",
            "license": "ME110882",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orlando, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2012; 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.