Central Florida Psychotherapy Services LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

CENTRAL FLORIDA PSYCHOTHERAPY SERVICES LLC

Practice address

5302 S Florida Ave Ste 200
Lakeland, FL 33813-4922

Phone

(853) 602-7001

Fax

(863) 583-8585

NPI assigned

Aug 19, 2020

Organization subpart

No

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

Authorized official

Name

Jomon Thekkethottiyil, LCSWNPI 1023376894

Title

Owner

Phone

(330) 416-3867

Specialties & licenses 1

Addresses

Other names 1

• Psychotherapy Services of Newlight Doing business as

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jomon John Thekkethottiyil

  • Clinical Social Worker
  • St Petersburg, FL
  • NPI 1023376894

  Clinical, FL

  Medicare reassignment NPD Authorized official
• Sibil Elavumkal

  • Psychiatric/Mental Health Nurse Practitioner
  • Seffner, FL
  • NPI 1750255840
  NPD
• Katherine Padinjath

  • Family Nurse Practitioner
  • Bartow, FL
  • NPI 1760026652
  NPD
• Jessy Sebastian, LCSW

  • Clinical Social Worker
  • Clearwater, FL
  • NPI 1467016170

  Clinical

  NPD
• Julie Shaju, APRN

  • Family Nurse Practitioner
  • Tampa, FL
  • NPI 1063998631
  NPD
• Panchami Thomas, APRN

  • Psychiatric/Mental Health Nurse Practitioner
  • Lake Wales, FL
  • NPI 1336689819
  NPD
• Shelly Thomas, PMHNP-BC, APRN, RN.

  • Psychiatric/Mental Health Nurse Practitioner
  • Euless, TX
  • NPI 1396330478
  NPD

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

{
    "created_epoch": "1597795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597795200000",
    "number": "1689286809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5302 S FLORIDA AVE STE 203",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338134910",
            "telephone_number": "863-602-7001",
            "fax_number": "863-583-8585"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5302 S FLORIDA AVE STE 200",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338134922",
            "telephone_number": "853-602-7001",
            "fax_number": "863-583-8585"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL FLORIDA PSYCHOTHERAPY SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-19",
        "last_updated": "2020-08-19",
        "certification_date": "2020-08-19",
        "status": "A",
        "authorized_official_last_name": "THEKKETHOTTIYIL",
        "authorized_official_first_name": "JOMON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "330-416-3867",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Psychotherapy Services of Newlight",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Taylor A Cepero

• Clinical Social Worker in Lakeland, FL
• Providers in Lakeland, FL by specialty
• Clinical Social Worker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 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.