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General NPI Number Information
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NPI Number | 1184871568
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Entity Type | Organization
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Legal Business Name | EMILY C PTASZEK PSYD PA
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Dates
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Enumeration Date | 08/27/2008
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Last Update Date | 12/11/2008
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Provider Practice Location Address
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Address Line | 5245 RAMSEY WAY SUITE 1
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City | FORT MYERS
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State | FL
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Zip | 33907-2124
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Country | US
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Telephone | 407-314-1650
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Fax |
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Provider Business Mailing Address
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Address Line | 1313 CALOOSA VISTA RD
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City | FORT MYERS
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State | FL
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Zip | 33901-8805
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Country | US
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Telephone | 239-362-2802
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Fax |
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Authorized Official
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Title or Position | DIRECTOR/LICENSED PSYCHOLOGIST
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Name | DR. EMILY C PTASZEK
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Credential | PSY.D.
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Telephone | 407-314-1650
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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 | PY 7057
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License Number State | FL
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