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General NPI Number Information
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NPI Number | 1588108096
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Entity Type | Organization
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Legal Business Name | FAMILY PSYCHOLOGY OF ORLANDO
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Dates
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Enumeration Date | 12/19/2016
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Last Update Date | 12/19/2016
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Provider Practice Location Address
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Address Line | 5025 S ORANGE AVE SUITE 202
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City | ORLANDO
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State | FL
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Zip | 32809-3065
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Country | US
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Telephone | 407-985-1927
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Fax |
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Provider Business Mailing Address
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Address Line | 5025 S ORANGE AVE SUITE 202
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City | ORLANDO
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State | FL
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Zip | 32809-3065
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARY VILAR
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Credential |
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Telephone | 407-985-1927
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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 | PY7840
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License Number State | FL
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