Systemic Innovations, LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

MH9903 Issued in FL

Legal business name

SYSTEMIC INNOVATIONS, LLC

Practice address

406 Lake Howell Rd
Maitland, FL 32751-5907

Phone

(407) 691-3960

Fax

(407) 691-3961

NPI assigned

May 1, 2014

Organization subpart

No

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

Authorized official

Name

Julie D Eberwein, PHD, LMHC, CAP

Title

Owner

Phone

(407) 691-3960

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Julie Eberwein PHD, LMHC Former legal business name

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

{
    "created_epoch": "1398902400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1401840000000",
    "number": "1568872372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "406 LAKE HOWELL RD",
            "city": "MAITLAND",
            "state": "FL",
            "postal_code": "327515907",
            "telephone_number": "407-691-3960",
            "fax_number": "407-691-3961"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "406 LAKE HOWELL RD",
            "city": "MAITLAND",
            "state": "FL",
            "postal_code": "327515907",
            "telephone_number": "407-691-3960",
            "fax_number": "407-691-3961"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SYSTEMIC INNOVATIONS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-01",
        "last_updated": "2014-06-04",
        "status": "A",
        "authorized_official_last_name": "EBERWEIN",
        "authorized_official_first_name": "JULIE",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "407-691-3960",
        "authorized_official_credential": "PHD, LMHC, CAP"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "FL",
            "license": "MH9903",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001116400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Julie Eberwein PHD, LMHC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Community/Behavioral Health Agency in Maitland, FL
• Providers in Maitland, FL by specialty
• Community/Behavioral Health Agency in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2014; 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.