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General NPI Number Information
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NPI Number | 1356539175
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Entity Type | Organization
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Legal Business Name | SUSAN R KING PSYD PA
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Dates
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Enumeration Date | 10/05/2007
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Last Update Date | 04/25/2008
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Provider Practice Location Address
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Address Line | 5245 RAMSEY WAY STE 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 | 239-929-0274
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Fax | 239-437-5913
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Provider Business Mailing Address
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Address Line | 5245 RAMSEY WAY STE 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 | 239-929-0274
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Fax | 239-437-5913
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | SUSAN R KING
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Credential | PSY D PA
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Telephone | 239-929-0274
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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 | 0701501
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License Number State | FL
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