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General NPI Number Information
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NPI Number | 1013202571
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Entity Type | Organization
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Legal Business Name | THOMAS F. GUIDERA, PH.D, P.A.
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Dates
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Enumeration Date | 06/13/2011
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Last Update Date | 05/15/2012
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Provider Practice Location Address
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Address Line | 1777 GARDEN STREET
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City | TITUSVILLE
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State | FL
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Zip | 32796-3221
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Country | US
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Telephone | 321-268-5682
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Fax | 321-268-5683
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Provider Business Mailing Address
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Address Line | 1777 GARDEN STREET
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City | TITUSVILLE
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State | FL
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Zip | 32796-3221
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Country | US
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Telephone | 321-268-5682
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Fax | 321-268-5683
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Authorized Official
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Title or Position | OWNER-PRACTITIONER
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Name | DR. THOMAS F GUIDERA
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Credential | PH.D., PA
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Telephone | 321-268-5682
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PY 3165
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY0003165
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License Number State | FL
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