| NPI | 1396146981 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAMELA DENISE GREEN Secretary 407-365-2599 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY2246) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: FL PY2246) |
| 103TH0004X Psychologist, Health (Licence: FL PY2246) | |
| Enumeration Date | 2014-09-15 |
| Last Update Date | 2014-09-15 |