Provider Demographics
NPI:1699937466
Name:BEHAVIORAL MEDICINE & PSYCHOTHERAPY LLC
Entity type:Organization
Organization Name:BEHAVIORAL MEDICINE & PSYCHOTHERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:MANUEL
Authorized Official - Last Name:VINUELA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-704-3042
Mailing Address - Street 1:2401 W EAU GALLIE BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-2765
Mailing Address - Country:US
Mailing Address - Phone:321-327-5952
Mailing Address - Fax:321-327-5954
Practice Address - Street 1:2340 DAIRY RD
Practice Address - Street 2:SUITE 104
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-5246
Practice Address - Country:US
Practice Address - Phone:321-327-5952
Practice Address - Fax:321-327-5954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-01
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME945552084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1710943311OtherNPI