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General NPI Number Information
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NPI Number | 1710204292
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Entity Type | Organization
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Legal Business Name | LEESBURG PSYCHOLOGY
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Dates
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Enumeration Date | 04/23/2010
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Last Update Date | 05/10/2010
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Provider Practice Location Address
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Address Line | 8529 US HIGHWAY 441
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City | LEESBURG
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State | FL
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Zip | 34788-4021
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Country | US
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Telephone | 352-787-7144
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Fax | 352-450-7600
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Provider Business Mailing Address
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Address Line | 8529 US HIGHWAY 441
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City | LEESBURG
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State | FL
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Zip | 34788-4021
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Country | US
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Telephone | 352-787-7144
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Fax | 352-450-7600
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Authorized Official
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Title or Position | OWNER
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Name | DR. EVELYN R. BAEZ-ROJAS
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Credential | PH.D.
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Telephone | 352-787-7144
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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 | PY4794
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License Number State | FL
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