Provider Demographics
NPI:1154196376
Name:PALMETTO PSYCHIATRY & WELLNESS
Entity type:Organization
Organization Name:PALMETTO PSYCHIATRY & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CELESTE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:860-878-8447
Mailing Address - Street 1:PO BOX 562
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:SC
Mailing Address - Zip Code:29679-0562
Mailing Address - Country:US
Mailing Address - Phone:860-878-8447
Mailing Address - Fax:312-535-6816
Practice Address - Street 1:815 ROBIN DR STE B
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29678-2653
Practice Address - Country:US
Practice Address - Phone:864-614-1555
Practice Address - Fax:312-535-6816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-17
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty