Healthcare Provider Details

I. General information

NPI: 1891131637
Provider Name (Legal Business Name): PRIMARY PSYCHOLOGY OF CENTRAL FLORIDA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2013
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2521 13TH ST STE F
SAINT CLOUD FL
34769-4103
US

IV. Provider business mailing address

2521 13TH ST STE F
SAINT CLOUD FL
34769-4103
US

V. Phone/Fax

Practice location:
  • Phone: 407-900-4885
  • Fax: 866-515-9293
Mailing address:
  • Phone: 407-900-4885
  • Fax: 866-515-9293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: YAMILA SANTOS
Title or Position: PSYCHOLOGIST
Credential: PH.D.
Phone: 407-900-4885