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General NPI Number Information
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NPI Number | 1326646654
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Entity Type | Organization
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Legal Business Name | MOVIMENTUM PSYCHOLOGY LLC
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Dates
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Enumeration Date | 10/09/2020
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Last Update Date | 01/14/2021
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Provider Practice Location Address
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Address Line | 1317 EDGEWATER DR UNIT 902
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City | ORLANDO
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State | FL
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Zip | 32804-6350
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Country | US
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Telephone | 239-329-8742
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Fax |
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Provider Business Mailing Address
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Address Line | 1317 EDGEWATER DR STE 902
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City | ORLANDO
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State | FL
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Zip | 32804-6350
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Country | US
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Telephone | 509-851-5084
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Fax |
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Authorized Official
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Title or Position | MANAGER/CO-OWNER
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Name | ANGELIQUE MELENDEZ-BLANCH
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Credential | PSYD
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Telephone | 509-851-5084
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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