Beaches Behavioral Health LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

SW13084 Issued in FL

Legal business name

BEACHES BEHAVIORAL HEALTH LLC

Doing business as

PsychLife

Practice address

3733 University Blvd W Ste 209
Jacksonville, FL 32217-2103

Phone

(904) 543-6055

Fax

(904) 395-9181

NPI assigned

Oct 23, 2015

Organization subpart

No

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

Authorized official

Name

Lisa J Rotella, LCSWNPI 1174943815

Title

Owner

Phone

(610) 331-2645

Specialties & licenses 1

Addresses

Other names 1

• PsychLife Doing business as

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 1

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

• Lisa Rotella

  • Clinical Social Worker
  • Jacksonville, FL
  • NPI 1174943815
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1445558400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631836800000",
    "number": "1770955254",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6652 EPPING FOREST WAY N",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322172648",
            "telephone_number": "904-280-0790",
            "fax_number": "904-395-9181"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3733 UNIVERSITY BLVD W STE 209",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322172103",
            "telephone_number": "904-543-6055",
            "fax_number": "904-395-9181"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEACHES BEHAVIORAL HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-23",
        "last_updated": "2021-09-17",
        "certification_date": "2021-09-17",
        "status": "A",
        "authorized_official_last_name": "ROTELLA",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "610-331-2645",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW13084",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PsychLife",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PsychLife",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Beach Medical Specialist PA
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• Lynn Lashay Beach, CAPT / MC / USN
• Pamela Beach, APRN
• Kiara Beacham
• Beaches Behavioral, Inc. (Beaches Behavioral)
• Beaches Pediatrics, PA
• Beaches Pharmacy LLC
• Beaches Recovery Services LLC
• Beaches Urology PA

• Clinical Social Worker in Jacksonville, FL
• Providers in Jacksonville, 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 Sep 17, 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.