Clearwater Emdr LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

CLEARWATER EMDR LLC

Practice address

2430 Estancia Blvd Ste 100a
Clearwater, FL 33761-2644

Phone

(727) 316-5740

Fax

(833) 216-5165

NPI assigned

Oct 7, 2021

Last updated

Oct 7, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Marie Vagedes, LCSWNPI 1740470236

Title

Owner

Phone

(727) 316-5740

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Marie Angela Vagedes, LCSW

  • Clinical Social Worker
  • Clearwater, FL
  • NPI 1740470236
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1633564800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1633564800000",
    "number": "1417619446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2430 ESTANCIA BLVD STE 100A",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337612644",
            "telephone_number": "727-316-5740",
            "fax_number": "833-216-5165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2430 ESTANCIA BLVD STE 100A",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337612644",
            "telephone_number": "727-316-5740",
            "fax_number": "833-216-5165"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLEARWATER EMDR LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-07",
        "last_updated": "2021-10-07",
        "certification_date": "2021-10-07",
        "status": "A",
        "authorized_official_last_name": "VAGEDES",
        "authorized_official_first_name": "MARIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "727-316-5740",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Clearwater Dental Care PLLC
• Clearwater Dentistry
• Clearwater Dermatologic & Aesthetic Institute PA
• Clearwater Dermatology, P.a.
• Clearwater Dreams Dental PA
• Clearwater Emergency Physicians
• Clearwater Family Medicine and Allergy, PA
• Clearwater Family Practice, PA
• Clearwater FL Opco LLC (Sand Key Health and Rehabilitation Center)
• Clearwater Free Clinic, Inc.

• Mental Health Clinic/Center (Including Community Mental Health Center) in Clearwater, FL
• Providers in Clearwater, FL by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.