| NPI | 1417183419 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN R. THIBODEAU Sole Member 321-972-5693 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY 7684) |
| Enumeration Date | 2009-06-04 |
| Last Update Date | 2009-06-04 |