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General NPI Number Information
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NPI Number | 1629780341
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Entity Type | Individual
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Provider Name | LOUIS VANDERLICK IV
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Gender | Male
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Dates
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Enumeration Date | 12/14/2022
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Last Update Date | 05/14/2025
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Provider Practice Location Address
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Address Line | 1535 W NASA BLVD # C-1
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City | MELBOURNE
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State | FL
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Zip | 32901-2614
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Country | US
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Telephone | 321-235-6199
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Fax | 321-821-1975
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Provider Business Mailing Address
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Address Line | 300 INTERNATIONAL PKWY STE 200
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City | LAKE MARY
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State | FL
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Zip | 32746-5028
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Country | US
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Telephone | 610-866-0580
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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 | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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License Number |
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License Number State |
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