MEDICARE: ELOISE STIGLITZ PHD LLC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1851888408
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELOISE STIGLITZ PHD LLC

Provider Business Mailing Address
First Line	:	1121 WEBSTER AVE
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32804-2852
Country	:	US
Telephone Number	:	510-468-4633
Fax Number	:

Provider Business Practice Location Address
First Line	:	1121 WEBSTER AVE
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32804-2852
Country	:	US
Telephone Number	:	510-468-4633
Fax Number	:

Authorized Official
Title or Position	:	SOLE MEMBER
Name	:	ELOISE STIGLITZ
Credential	:	PHD
Telephone Number	:	510-468-4633

Provider Enumeration Date	:	04/19/2018
Last Update Date	:	04/19/2018

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