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General NPI Number Information
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NPI Number | 1386699213
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Entity Type | Individual
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Provider Name | LOUISE URBANC PETERS PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 05/22/2006
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Last Update Date | 12/10/2021
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Provider Practice Location Address
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Address Line | 6103 N ATLANTIC AVE STE C
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City | CAPE CANAVERAL
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State | FL
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Zip | 32920-3976
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Country | US
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Telephone | 321-514-2878
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Fax | 954-944-0308
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Provider Business Mailing Address
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Address Line | 3730 BIG PINE RD
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City | MELBOURNE
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State | FL
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Zip | 32934-8536
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Country | US
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Telephone | 321-259-2745
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY7171
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License Number State | FL
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