Healthcare Provider Details

I. General information

NPI: 1174531420
Provider Name (Legal Business Name): GAIL J PURDY PHD, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 04/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11842 W WATERWAY DR
HOMOSASSA FL
34448-7312
US

IV. Provider business mailing address

11842 W WATERWAY DR
HOMOSASSA FL
34448-7312
US

V. Phone/Fax

Practice location:
  • Phone: 352-628-7611
  • Fax: 352-628-7644
Mailing address:
  • Phone: 352-628-7611
  • Fax: 352-628-7644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY 5901
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY 5901
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: