Healthcare Provider Details

I. General information

NPI: 1073862405
Provider Name (Legal Business Name): ERRIN E. PRICE PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2012
Last Update Date: 03/29/2021
Certification Date: 03/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15901 BASS RD STE 108
FORT MYERS FL
33908-3838
US

IV. Provider business mailing address

PO BOX 2147
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 239-343-6050
  • Fax: 239-343-6051
Mailing address:
  • Phone: 239-343-6050
  • Fax: 239-343-6051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2016043860
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPY10721
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: