| NPI | 1023477221 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER TICKAL Clinical Psychologist 321-217-6086 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: FL PY8723) |
| Enumeration Date | 2016-02-16 |
| Last Update Date | 2021-01-18 |