Healthcare Provider Details

I. General information

NPI: 1700576899
Provider Name (Legal Business Name): LAURIE KEMPER PSY D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2023
Last Update Date: 05/11/2023
Certification Date: 05/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

253 N ORLANDO AVE STE 202
MAITLAND FL
32751-5521
US

IV. Provider business mailing address

253 N ORLANDO AVE STE 202
MAITLAND FL
32751-5521
US

V. Phone/Fax

Practice location:
  • Phone: 407-790-4101
  • Fax: 407-277-4400
Mailing address:
  • Phone: 407-790-4101
  • Fax: 407-277-4400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: