MEDICARE: ARAGON PSYCHOLOGICAL SERVICES, LLC

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	PY9193	FL

General Provider Information

NPI Number	:	1073052205
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARAGON PSYCHOLOGICAL SERVICES, LLC

Provider Business Mailing Address
First Line	:	3605 BURDOCK AVE
Second Line	:
City	:	W MELBOURNE
State	:	FL
Zip	:	32904-7526
Country	:	US
Telephone Number	:	352-406-8966
Fax Number	:

Provider Business Practice Location Address
First Line	:	122 4TH AVE STE 200
Second Line	:
City	:	INDIALANTIC
State	:	FL
Zip	:	32903-3112
Country	:	US
Telephone Number	:	321-327-3793
Fax Number	:	321-327-7914

Authorized Official
Title or Position	:	OWNER/ CLINICAL PSYCHOLOGIST
Name	:	DR. PATRICK J ARAGON
Credential	:	PSY.D.
Telephone Number	:	321-327-3793

Provider Enumeration Date	:	02/21/2017
Last Update Date	:	02/21/2017

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