| NPI | 1619727690 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN SHACKET Psychologist 321-303-9593 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2024-03-25 |
| Last Update Date | 2024-06-02 |