| NPI | 1003190059 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FRED J PETRILLA President 772-562-0777 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL py0002507) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: FL ss33) |
| Enumeration Date | 2011-10-07 |
| Last Update Date | 2011-11-17 |