Provider Demographics
NPI:1104811272
Name:SEABREEZE BEHAVIORAL MEDICINE PA
Entity type:Organization
Organization Name:SEABREEZE BEHAVIORAL MEDICINE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BERNARDO
Authorized Official - Middle Name:J
Authorized Official - Last Name:ARIAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-766-9555
Mailing Address - Street 1:3191 HARBOR BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-6755
Mailing Address - Country:US
Mailing Address - Phone:941-766-9555
Mailing Address - Fax:941-766-1511
Practice Address - Street 1:3191 HARBOR BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-6755
Practice Address - Country:US
Practice Address - Phone:941-766-9555
Practice Address - Fax:941-766-1511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-15
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL260963100Medicaid
38239OtherB/C
38239OtherB/C