Panama Youth Services, Inc

Primary specialty

CounselorTaxonomy code 101Y00000X

License

0416AD444101 Issued in FL

Legal business name

PANAMA YOUTH SERVICES, INC

Practice address

7287 Wilder Ave
Jacksonville, FL 32208

Phone

(904) 527-3953

Fax

(904) 683-0067

NPI assigned

Sep 21, 2011

Organization subpart

No

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

Authorized official

Name

Mr. Willie James Green Jr., M.S.

Title

Executive Director

Phone

(904) 527-3953

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1316563200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1316563200000",
    "number": "1447533013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "402 EAST 63RD STREET",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "32208",
            "telephone_number": "904-527-3953",
            "fax_number": "904-683-0067"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7287 WILDER AVE",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "32208",
            "telephone_number": "904-527-3953",
            "fax_number": "904-683-0067"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PANAMA YOUTH SERVICES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-21",
        "last_updated": "2011-09-21",
        "status": "A",
        "authorized_official_last_name": "GREEN",
        "authorized_official_first_name": "WILLIE",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "904-527-3953",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "M.S."
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": "FL",
            "license": "0416AD444101",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joseph Palopoli III
• Pam Rillstone, PHD, CNS, BC, CT, PLLC
• Jessica Jayeshkumar Pambhar
• Michael Anthony Pammit, M.D.
• John L Panaccione, MD
• Betty Panampally
• Keith Raymond Panaro, PHYSICIAN ASSISTANT
• Valerija Pancenko
• Mark Pancirov, RAH
• Govind Panda, M.D.

• Counselor in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Counselor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2011; 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.