Provider Demographics
NPI:1699438549
Name:MCW PSYCH CARE MD, LLC
Entity type:Organization
Organization Name:MCW PSYCH CARE MD, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-497-5920
Mailing Address - Street 1:234 OLEANDER AVE APT 6
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33480-3824
Mailing Address - Country:US
Mailing Address - Phone:352-497-5920
Mailing Address - Fax:
Practice Address - Street 1:234 OLEANDER AVE APT 6
Practice Address - Street 2:
Practice Address - City:PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33480-3824
Practice Address - Country:US
Practice Address - Phone:352-497-5920
Practice Address - Fax:561-629-5240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-18
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL100556600Medicaid