Healthcare Provider Details

I. General information

NPI: 1922496850
Provider Name (Legal Business Name): FLORIDA PSYCHOLOGICAL ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2014
Last Update Date: 02/07/2025
Certification Date: 02/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1903 ISLAND WALK WAY
FERNANDINA FL
32034-4797
US

IV. Provider business mailing address

1903 ISLAND WALK WAY
FERNANDINA FL
32034-4797
US

V. Phone/Fax

Practice location:
  • Phone: 904-277-0027
  • Fax:
Mailing address:
  • Phone: 904-277-0027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberATN 581436
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DR. CATHERINE H DREW
Title or Position: CEO
Credential: PHD
Phone: 904-277-0027