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General NPI Number Information
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NPI Number | 1336490093
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Entity Type | Organization
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Legal Business Name | FLORIDA NEUROPSYCHOLOGY
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Dates
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Enumeration Date | 09/20/2012
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Last Update Date | 09/20/2012
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Provider Practice Location Address
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Address Line | 1501 S ALEXANDER ST SUITE 104
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City | PLANT CITY
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State | FL
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Zip | 33563-8408
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Country | US
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Telephone | 727-204-8318
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Fax |
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Provider Business Mailing Address
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Address Line | 3951 SERENADE LN
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City | LAKELAND
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State | FL
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Zip | 33811-8603
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | NEUROPSYCHOLOGIST
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Name | DR. JULIE A CARREO
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Credential | PSY.D.
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Telephone | 727-204-8318
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | PY8596
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License Number State | FL
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