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General NPI Number Information
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NPI Number | 1568763944
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Entity Type | Organization
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Legal Business Name | GEORGE MEDZERIAN PH.D. INC.
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Dates
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Enumeration Date | 11/16/2010
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Last Update Date | 11/16/2010
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Provider Practice Location Address
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Address Line | 428 SW 7TH ST
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City | STUART
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State | FL
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Zip | 34994-2908
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Country | US
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Telephone | 772-283-0013
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Fax | 772-219-4785
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Provider Business Mailing Address
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Address Line | 428 SW 7TH ST
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City | STUART
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State | FL
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Zip | 34994-2908
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Country | US
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Telephone | 772-283-0013
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Fax | 772-219-4785
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. GEORGE MEDZERIAN
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Credential | PH.D.
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Telephone | 772-485-0235
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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 | PY3086
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License Number State | FL
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