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General NPI Number Information
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NPI Number | 1366106908
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Entity Type | Organization
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Legal Business Name | HEAL & GROW PSYCHOLOGICAL SERVICES
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Dates
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Enumeration Date | 10/29/2021
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Last Update Date | 01/26/2022
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Provider Practice Location Address
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Address Line | 320 N CATTLEMEN RD APT 103
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City | SARASOTA
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State | FL
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Zip | 34232-6434
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Country | US
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Telephone | 941-564-9478
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Fax |
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Provider Business Mailing Address
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Address Line | 320 N CATTLEMEN RD APT 103
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City | SARASOTA
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State | FL
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Zip | 34232-6434
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Country | US
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Telephone | 941-564-9478
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MAGDALENA FUDYMA
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Credential | PSY.D.
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Telephone | 941-564-9478
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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 |
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License Number State |
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