Provider Demographics
NPI:1699595470
Name:MENTAL MEDIC, LLC.
Entity type:Organization
Organization Name:MENTAL MEDIC, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:EUGENIA
Authorized Official - Last Name:MORAN
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-PMH
Authorized Official - Phone:954-882-0942
Mailing Address - Street 1:4474 WESTON RD STE 102
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33331-3195
Mailing Address - Country:US
Mailing Address - Phone:954-380-5303
Mailing Address - Fax:
Practice Address - Street 1:1725 MAIN ST STE 219
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-3670
Practice Address - Country:US
Practice Address - Phone:954-380-5303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Single Specialty