NPIMap

Organization Active NPI

Live Oak Behavioral Health PA

  • Cognitive & Behavioral Psychologist
  • Maitland, FL
National Provider Identifier
1508368192
Registry record updated Oct 5, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cognitive & Behavioral PsychologistTaxonomy code 103TB0200X
License
PY9901 Issued in FL
Legal business name
LIVE OAK BEHAVIORAL HEALTH PA
Practice address
341 N Maitland Ave Ste 120
Maitland, FL 32751-4761
Phone
(407) 756-2084
Fax
(866) 495-2994
NPI assigned
Feb 28, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2020

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

Authorized official

Name
Dr. Daniel Paulson, PHDNPI 1659883239
Title
Co-Owner
Phone
(407) 756-2084

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cognitive & Behavioral PsychologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 103TB0200X PY9901 FL Primary

Addresses

Primary practice location

341 N Maitland Ave Ste 120
Maitland, FL 32751-4761

Mailing address

341 N Maitland Ave Ste 120
Maitland, FL 32751-4761
Phone (407) 756-2084

Other names 1

  • Live Oak Behavioral Health Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210301002205 FL Part B Supplier - Clinic/Group Practice 9032525969 Receives reassigned benefits from 6 practitioners
Practice locations: Maitland, FL

National Provider Directory

National Provider Directory

Locations

1355 S International Pkwy
Ste 2471
Lake Mary, FL 32746
Phone (321) 578-7378

341 N Maitland Ave
Ste 120
Maitland, FL 32751
Phone (407) 756-2084

Practitioners & affiliated clinicians

Practitioners 7

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": "1519776000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1601856000000",
    "number": "1508368192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "341 N MAITLAND AVE STE 120",
            "city": "MAITLAND",
            "state": "FL",
            "postal_code": "327514761",
            "telephone_number": "407-756-2084"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "341 N MAITLAND AVE STE 120",
            "city": "MAITLAND",
            "state": "FL",
            "postal_code": "327514761",
            "telephone_number": "407-756-2084",
            "fax_number": "866-495-2994"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIVE OAK BEHAVIORAL HEALTH PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-28",
        "last_updated": "2020-10-05",
        "certification_date": "2020-10-05",
        "status": "A",
        "authorized_official_last_name": "PAULSON",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "407-756-2084",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103TB0200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "FL",
            "license": "PY9901",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Live Oak Behavioral Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Maitland, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2020; 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.