Healthcare Provider Details

I. General information

NPI: 1689160384
Provider Name (Legal Business Name): ERYN GIAMMATTEI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2018
Last Update Date: 06/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W GORE ST STE 405
ORLANDO FL
32806-1049
US

IV. Provider business mailing address

100 W GORE ST STE 405
ORLANDO FL
32806-1049
US

V. Phone/Fax

Practice location:
  • Phone: 321-841-9340
  • Fax: 321-841-9344
Mailing address:
  • Phone: 321-841-9340
  • Fax: 321-841-9344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number14130
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: