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General NPI Number Information
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NPI Number | 1093999492
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Entity Type | Organization
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Legal Business Name | PAMELA A MARK LLC
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Dates
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Enumeration Date | 12/20/2007
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Last Update Date | 02/07/2012
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Provider Practice Location Address
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Address Line | 605 E ROBINSON ST SUITE 103
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City | ORLANDO
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State | FL
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Zip | 32801-2040
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Country | US
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Telephone | 407-697-7173
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Fax |
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Provider Business Mailing Address
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Address Line | 605 E ROBINSON ST SUITE 103
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City | ORLANDO
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State | FL
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Zip | 32801-2040
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Country | US
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Telephone | 407-697-7173
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | PAMELA A MARK
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Credential | PSYD
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Telephone | 407-697-7173
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY6747
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License Number State | FL
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