Healthcare Provider Details

I. General information

NPI: 1326588914
Provider Name (Legal Business Name): NEJAME PSYCHOLOGICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2017
Last Update Date: 05/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

266 THORNE MEADOW PASS
DAVENPORT FL
33897-4716
US

IV. Provider business mailing address

266 THORNE MEADOW PASS
DAVENPORT FL
33897-4716
US

V. Phone/Fax

Practice location:
  • Phone: 407-721-1512
  • Fax:
Mailing address:
  • Phone: 407-721-1512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberPY8805
License Number StateFL

VIII. Authorized Official

Name: DR. JULIE OLSON NEJAME
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PSY.D.
Phone: 407-488-4892