COLLABORATIVE PSYCH & MED (NPI# 1972088912) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1972088912 |
| Entity Type | Organization |
| Organization Name | COLLABORATIVE PSYCH & MED |
| Practice Address |
4406 S Florida Ave Ste 31 Lakeland FL 33813-2176 |
| Practice Telephone | 8557325292 |
| Practice Fax Number | 8635839926 |
| Mailing Telephone | 8557325292 |
| Mailing Fax Number | 8635839926 |
| Enumeration Date | 2018-09-26 |
| Last Update Date | 2018-09-26 |
| Authorized Official Name | KELLY WOOD (ADMINISTRATOR) |
| Authorized Official Telephone | 8557325292 |
| Authorized Official Credential | BSW |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 103TA0700X |
Psychologist Specialization: Adult Development & Aging |
Behavioral Health & Social Service Providers | ||
| N | 171M00000X | Case Manager/Care Coordinator | Other Service Providers | ||
| Y | 2084P0805X |
Psychiatry & Neurology Specialization: Geriatric Psychiatry |
Allopathic & Osteopathic Physicians |
| Street Address |
4406 S FLORIDA AVE STE 31 |
| City | LAKELAND |
| State | FL |
| Zip Code | 33813-2176 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427600030 | Genesis Vieyra Lopez | Nurse Practitioner | 631 Mid Florida Drive, Lakeland, FL 33813 | 2019-07-13 |
| 1306323340 | Sandrene Smart | Clinic/Center | 625 Commerce Dr. (suite 103), Lakeland, FL 33813 | 2018-07-23 |
| 1033560586 | Charles D. Llano, D.d.s. | Dentist | 320 West Highland Drive, Lakeland, FL 33813 | 2016-06-27 |
| 1417317389 | Eye Specialists of Mid-florida, Pa | Ophthalmology | 2004 Cr 540 A, Lakeland, FL 33813 | 2016-03-04 |
| 1609234905 | Care and Life LLC | In Home Supportive Care | 6526 Fox Tree Lane, Lakeland, FL 33813 | 2016-02-02 |
| 1558731158 | Lori Ann Smith | Nurse Practitioner | 6030 S. Florida Ave, Suite 110, Lakeland, FL 33813 | 2015-09-25 |
| 1891182143 | Advanced Integrated Care Organization, LLC | Health Maintenance Organization | 5423 S. Florida Ave, Lakeland, FL 33813 | 2015-04-23 |
| 1902292352 | Central Health Associates | Internal Medicine | 4925 Old Rd 37, Lakeland, FL 33813 | 2015-04-13 |
| 1134542848 | Gledia Lovering | Dietitian, Registered | 6420 Highlands In The Woods St, Lakeland, FL 33813 | 2014-01-31 |
| 1134556368 | Billy Rogers | Nurse Anesthetist, Certified Registered | 4513 Orangewood Loop W., Lakeland, FL 33813 | 2013-10-02 |
| Find all providers in zip 33813 | ||||
| Taxonomy Code | 2084P0805X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Geriatric Psychiatry |
| Geriatric Psychiatry is a subspecialty with psychiatric expertise in prevention, evaluation, diagnosis and treatment of mental and emotional disorders in the elderly, and improvement of psychiatric care for healthy and ill elderly patients. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982205290 | Slrc Miami Medical LLC | Psychiatry & Neurology | 601 Brickell Key Dr, Miami, FL 33131-2662 | 2020-11-03 |
| 1225674849 | Slrc Jacksonville LLC | Psychiatry & Neurology | 14286 Beach Blvd Ste 118, Jacksonville, FL 32250-1561 | 2019-11-19 |
| 1790248466 | Waves of Wellness | Psychiatry & Neurology | 10 Se Central Pkwy Ste 225, Stuart, FL 34994-5920 | 2019-04-10 |
| 1548753718 | Good Health Outcomes, Inc. | Psychiatry & Neurology | 1200 4th St Ste 308, Key West, FL 33040-3763 | 2018-06-12 |
| 1013374354 | New Horizons Mental Health LLC | Psychiatry & Neurology | 12130 Cortez Blvd, Brooksville, FL 34613-5575 | 2016-01-18 |
| 1174913958 | Lee County Associates In Psychiatry | Psychiatry & Neurology | 1303 Homestead Rd N Ste 103, Lehigh Acres, FL 33936-6049 | 2015-01-30 |
| 1558609156 | Milagros C. Pescador | Psychiatry & Neurology | 5208 Touraine Dr, Tallahassee, FL 32308-5934 | 2013-01-17 |
| 1992063002 | Marilyn Horvath Md Pa | Psychiatry & Neurology | 4317 Sw 186th Ave, Miramar, FL 33029-2772 | 2012-04-26 |
| 1295044873 | Kelly L Dunn Md Pa | Psychiatry & Neurology | 1696 W Hibiscus Blvd Ste A, Melbourne, FL 32901-2638 | 2010-09-30 |
| 1083928527 | Gerocare Consulting LLC | Psychiatry & Neurology | 17332 Garden Heath Ct, Land O Lakes, FL 34638-8089 | 2010-07-26 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.