Healthcare Provider Details

I. General information

NPI: 1780912709
Provider Name (Legal Business Name): FLORIDA COUNSELING CENTERS OF ORLANDO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2009
Last Update Date: 12/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1299 BEDFORD DR SUITE A
MELBOURNE FL
32940-1900
US

IV. Provider business mailing address

1299 BEDFORD DR SUITE A
MELBOURNE FL
32940-1900
US

V. Phone/Fax

Practice location:
  • Phone: 321-259-1662
  • Fax: 321-259-1223
Mailing address:
  • Phone: 321-259-1662
  • Fax: 321-259-1223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberPY6964
License Number StateFL

VIII. Authorized Official

Name: DR. RICHARD MICHAEL RONSISVALLE
Title or Position: FOUNDER/PRESIDENT
Credential: PSY.D.
Phone: 321-259-1662