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General NPI Number Information
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NPI Number | 1619297041
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Entity Type | Organization
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Legal Business Name | CLINICAL PSYCHOLOGY PROFESSIONAL CENTER LLC
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Dates
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Enumeration Date | 06/08/2010
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Last Update Date | 07/07/2010
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Provider Practice Location Address
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Address Line | 738 N MACEWEN DR
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City | OSPREY
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State | FL
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Zip | 34229-3200
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Country | US
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Telephone | 813-334-6222
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Fax | 941-966-0887
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Provider Business Mailing Address
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Address Line | 738 N MACEWEN DR
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City | OSPREY
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State | FL
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Zip | 34229-3200
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Country | US
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Telephone | 813-334-6222
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Fax | 941-966-0887
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | DR. GABRIELA CINTIA LODEIRO
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Credential | PSY.D.
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Telephone | 813-334-6222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | PY8074
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License Number State | FL
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