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General NPI Number Information
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NPI Number | 1295163384
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Entity Type | Individual
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Provider Name | JUDITH FAITH LEGAULT PH.D., ED.D.
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Gender | Female
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Dates
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Enumeration Date | 10/29/2013
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Last Update Date | 10/29/2013
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Provider Practice Location Address
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Address Line | 5201 RAYMOND ST
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City | ORLANDO
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State | FL
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Zip | 32803-8208
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Country | US
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Telephone | 321-397-6159
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Fax |
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Provider Business Mailing Address
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Address Line | 810 POINT PLEASANT PL
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City | ALTAMONTE SPRINGS
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State | FL
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Zip | 32701-6218
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Country | US
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Telephone | 407-595-5176
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 8889
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License Number State | FL
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