MEDICARE: EARL FRANK RECTANUS JR. PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PY4126	FL

General Provider Information

NPI Number	:	1003821935
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EARL FRANK RECTANUS JR. PH.D.

Provider Business Mailing Address
First Line	:	2430 VANDERBILT BEACH RD STE 108430
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34109-2654
Country	:	US
Telephone Number	:	239-262-6700
Fax Number	:	239-294-3759

Provider Business Practice Location Address
First Line	:	2430 VANDERBILT BEACH RD STE 108430
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34109-2654
Country	:	US
Telephone Number	:	239-262-6700
Fax Number	:	239-294-3759

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2006
Last Update Date	:	09/21/2024

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