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General NPI Number Information
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NPI Number | 1518339944
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Entity Type | Organization
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Legal Business Name | FLORIDA PSYCHOLOGY CENTER, LLC
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Dates
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Enumeration Date | 10/25/2015
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Last Update Date | 10/25/2015
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Provider Practice Location Address
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Address Line | 1030 E LAFAYETTE ST STE 8
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City | TALLAHASSEE
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State | FL
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Zip | 32301-4547
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Country | US
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Telephone | 201-484-9383
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Fax |
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Provider Business Mailing Address
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Address Line | 8819 MINNOW CREEK DR
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City | TALLAHASSEE
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State | FL
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Zip | 32312-5041
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Country | US
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Telephone | 201-484-9383
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Fax |
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST
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Name | DR. COLLEEN MOCCO
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Credential | PH.D.
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Telephone | 201-484-9383
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | PY9289
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License Number State | FL
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