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Behavioral Health & Social Service Providers Psychologist Clinical

Provider NPI: 1093041410

Provider Information:
Gender: F
Sole Proprietor

Practice Location:
3256 W LAKE MARY BLVD SUITE 1100 LAKE MARY, FL 32746-3588 US
Tel: 407-284-1191  Fax: --

Business Mailing Address:
Tel: 407-284-1191  Fax: --

NPI Information:
NPI: 1093041410
Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
Y103TC0700XBehavioral Health & Social Service Providers

Other Provider Identifiers:


American Medical Association 2012 taxonomy code information

Code: 103TC0700X





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