MEDICARE: FAMILY PSYCHOLOGY OF ORLANDO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	PY7840	FL

General Provider Information

NPI Number	:	1588108096
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY PSYCHOLOGY OF ORLANDO

Provider Business Mailing Address
First Line	:	5025 S ORANGE AVE
Second Line	:	SUITE 202
City	:	ORLANDO
State	:	FL
Zip	:	32809-3065
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5025 S ORANGE AVE
Second Line	:	SUITE 202
City	:	ORLANDO
State	:	FL
Zip	:	32809-3065
Country	:	US
Telephone Number	:	407-985-1927
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MARY VILAR
Credential	:
Telephone Number	:	407-985-1927

Provider Enumeration Date	:	12/19/2016
Last Update Date	:	12/19/2016

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