Deep River Psychological Services LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

PY5572 Issued in FL

Legal business name

DEEP RIVER PSYCHOLOGICAL SERVICES LLC

Practice address

323 10TH Ave W
Suite 302
Palmetto, FL 34221-5047

Phone

(941) 721-6325

Fax

(941) 723-6741

NPI assigned

Jul 26, 2013

Organization subpart

No

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

Authorized official

Name

Dr. Jennifer H Mendoza, PHD

Title

Owner/Psychologist

Phone

(941) 721-6325

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1374796800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1376524800000",
    "number": "1386086726",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "323 10TH AVE W",
            "address_2": "SUITE 302",
            "city": "PALMETTO",
            "state": "FL",
            "postal_code": "342215047",
            "telephone_number": "941-721-6325",
            "fax_number": "941-723-6741"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "323 10TH AVE W",
            "address_2": "SUITE 302",
            "city": "PALMETTO",
            "state": "FL",
            "postal_code": "342215047",
            "telephone_number": "941-721-6325",
            "fax_number": "941-723-6741"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEEP RIVER PSYCHOLOGICAL SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-26",
        "last_updated": "2013-08-15",
        "status": "A",
        "authorized_official_last_name": "MENDOZA",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "OWNER/PSYCHOLOGIST",
        "authorized_official_telephone_number": "941-721-6325",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "FL",
            "license": "PY5572",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Victoria Daniels, PTA
• Courtney Davidson
• Nicole L Davis, PHARMD
• Peyton Elise Davis, MS, LAT, ATC
• Jane Arrington Dawson, APRN
• Nicole A Deitrick, LMT
• Diamond Family Medicine PLLC Donita Kay Diamond Sole MBR
• Melanie Diaz Berrios, DC
• Anita Diaz, COTA
• Suzette Maya Dibattista, OTR/L

• Clinic/Center in Palmetto, FL
• Providers in Palmetto, FL by specialty
• Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 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.