Organization
LAKE MARY PSYCHIATRIC SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MANUEL R. MOTA-CASTILLO M.D. (PSYCHIATRIC/MEDICAL DIRECTOR)
(407) 330-5818
Entity
Organization
Contact information
Practice address
101 TIMBERLACHEN CIR, SUITE 201, LAKE MARY, FL 32746-6124
(407) 330-5818
(407) 330-5820
Mailing address
101 TIMBERLACHEN CIR, SUITE 201, LAKE MARY, FL 32746-6124
(407) 330-5818
(407) 330-5820
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
ME-82747
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110962
AMERIGROUP
FL
01
—
111973343307
MENTAL HEALTH NETWORK
FL
01
—
272693
HARMONY BEHAVIORAL HEALTH
FL
01
—
52339
BLUE CROSS BLUE SHIELD
FL
01
—
543580
VALUE OPTIONS
FL
01
—
7771009
AETNA
FL
Enumeration date
06/17/2006
Last updated
08/22/2020
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