MEDICARE: GARY J LOVETTE PH.D.

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	PY7339	FL

General Provider Information

NPI Number	:	1699813980
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARY J LOVETTE PH.D.

Provider Business Mailing Address
First Line	:	1275 S PATRICK DR STE D
Second Line	:
City	:	SATELLITE BEACH
State	:	FL
Zip	:	32937-3968
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1275 S PATRICK DR STE D
Second Line	:
City	:	SATELLITE BEACH
State	:	FL
Zip	:	32937-3968
Country	:	US
Telephone Number	:	321-779-0213
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/01/2007
Last Update Date	:	07/08/2007

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