Healthcare Provider Details

I. General information

NPI: 1063523678
Provider Name (Legal Business Name): HARALD WOLFGANG LETTNER PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 02/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 GOODLETTE RD N STE C 104
NAPLES FL
34102-5661
US

IV. Provider business mailing address

501 GOODLETTE RD N STE C 104
NAPLES FL
34102-5661
US

V. Phone/Fax

Practice location:
  • Phone: 239-434-6111
  • Fax: 239-649-0472
Mailing address:
  • Phone: 239-434-6111
  • Fax: 239-649-0472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPY4878
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY4878
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: