| NPI | 1306039243 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT C COOLIDGE Agent/Representative 386-774-5211 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: FL PY6399) |
| Enumeration Date | 2007-08-23 |
| Last Update Date | 2008-04-20 |