Healthcare Provider Details

I. General information

NPI: 1427463850
Provider Name (Legal Business Name): WESLEY PETER BLITCHINGTON, PH.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2014
Last Update Date: 06/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2909 W STATE ROAD 434 STE 111
LONGWOOD FL
32779-4459
US

IV. Provider business mailing address

2909 W STATE ROAD 434 STE 111
LONGWOOD FL
32779-4459
US

V. Phone/Fax

Practice location:
  • Phone: 407-774-0557
  • Fax: 407-774-9329
Mailing address:
  • Phone: 407-774-0557
  • Fax: 407-774-9329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY3223
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPY3223
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY3223
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPY3223
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License NumberPY3223
License Number StateFL

VIII. Authorized Official

Name: WESLEY PETER BLITCHINGTON
Title or Position: PSYCHOLOGIST/OWNER
Credential: PH.D.
Phone: 407-774-0557