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General NPI Number Information
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NPI Number | 1326419029
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Entity Type | Organization
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Legal Business Name | FLORIDA PSYCHOLOGICAL & ASSOCIATED HEALTHCARE
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Dates
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Enumeration Date | 10/07/2015
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Last Update Date | 05/09/2017
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Provider Practice Location Address
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Address Line | 1903 ISLAND WALK WAY
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City | FERNANDINA BEACH
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State | FL
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Zip | 32034-4797
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Country | US
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Telephone | 904-277-0027
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Fax | 407-867-6261
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Provider Business Mailing Address
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Address Line | 1903 ISLAND WALK WAY
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City | FERNANDINA BEACH
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State | FL
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Zip | 32034-4797
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Country | US
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Telephone | 904-277-0027
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Fax | 407-867-6261
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Authorized Official
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Title or Position | CEO
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Name | CATHERINE H DREW
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Credential | PHD
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Telephone | 904-277-0027
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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 9101
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License Number State | FL
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