Healthcare Provider Details

I. General information

NPI: 1912672163
Provider Name (Legal Business Name): LINDSAY JANE EATMAN PSY.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2021
Last Update Date: 08/10/2021
Certification Date: 08/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1370 BEDFORD DR STE 106
MELBOURNE FL
32940-1993
US

IV. Provider business mailing address

1370 BEDFORD DR STE 106
MELBOURNE FL
32940-1993
US

V. Phone/Fax

Practice location:
  • Phone: 321-253-8887
  • Fax: 321-253-8878
Mailing address:
  • Phone: 321-253-8887
  • Fax: 321-253-8878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY11161
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: