Provider Demographics
NPI:1053532028
Name:RICHARD J SASSATELLI INC
Entity type:Organization
Organization Name:RICHARD J SASSATELLI INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:SASSATELLI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:863-314-0622
Mailing Address - Street 1:104 MEDICAL CENTER AVE
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-5422
Mailing Address - Country:US
Mailing Address - Phone:863-314-0622
Mailing Address - Fax:863-314-9640
Practice Address - Street 1:104 MEDICAL CENTER AVE
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-5422
Practice Address - Country:US
Practice Address - Phone:863-314-0622
Practice Address - Fax:863-314-9640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5361103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAF763Medicare PIN