Organization
LAKE MARY PSYCHIATRY AND COUNSELING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY KROTENBERG D.O. (MANAGING MEMBER)
(407) 324-0405
Entity
Organization
Contact information
Practice address
305 WAYMONT CT, STE 111, LAKE MARY, FL 32746-3566
(407) 324-0405
(407) 324-0075
Mailing address
PO BOX 951468, LAKE MARY, FL 32795-1468
(407) 324-0405
(407) 324-0075
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
OS4985
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
056251300
—
FL
01
—
066470
VALUE OPTIONS
—
Enumeration date
10/23/2013
Last updated
10/23/2013
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