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General NPI Number Information
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NPI Number | 1154033660
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Entity Type | Organization
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Legal Business Name | IMI OLA
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Dates
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Enumeration Date | 12/15/2022
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Last Update Date | 06/01/2023
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Provider Practice Location Address
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Address Line | 3955 FOOSHE AVE
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City | MICCO
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State | FL
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Zip | 32976-2940
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Country | US
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Telephone | 808-646-1497
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Fax |
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Provider Business Mailing Address
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Address Line | 3955 FOOSHE AVE
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City | MICCO
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State | FL
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Zip | 32976-2940
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Country | US
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Telephone | 808-646-1497
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Fax |
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Authorized Official
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Title or Position | OWNER, LICENSED CLINICAL PSYCHOLOGI
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Name | DR. STEPHANIE NAPOLI
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Credential | PSY.D.
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Telephone | 808-646-1497
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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 |
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License Number State |
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