| NPI | 1922335017 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONNA ROSE Office Manager 352-331-0020 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY6140) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: FL PY6140) |
| 103TH0100X Psychologist, Health Service (Licence: FL PY6140) | |
| Enumeration Date | 2009-11-10 |
| Last Update Date | 2009-11-10 |