| NPI | 1942516844 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MABEL LOPEZ Owner 239-768-6500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: FL PY7375) |
| Additional Taxonomies | 103TB0200X Psychologist Cognitive & Behavioral (Licence: FL PY7375) |
| 103TC0700X Psychologist Clinical (Licence: FL PY7375) | |
| 103TC1900X Psychologist Counseling (Licence: FL PY7375) | |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: FL PY7375) | |
| 103TF0200X Psychologist Forensic (Licence: FL PY7375) | |
| 103TM1800X Psychologist Mental Retardation & Developmental Disabilities (Licence: FL PY7375) | |
| Enumeration Date | 2010-08-30 |
| Last Update Date | 2023-12-11 |