MEDICARE: DR. CHRISTINE MARIE NEEDHAM ED.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	103T00000X	Psychologist	SS0000297	FL

General Provider Information

NPI Number	:	1164727558
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTINE MARIE NEEDHAM ED.D.

Provider Business Mailing Address
First Line	:	17597 ROCKEFELLER CIR
Second Line	:	SUITE 2
City	:	FORT MYERS
State	:	FL
Zip	:	33967-5802
Country	:	US
Telephone Number	:	239-267-0887
Fax Number	:	239-267-0823

Provider Business Practice Location Address
First Line	:	17597 ROCKEFELLER CIR
Second Line	:	SUITE 2
City	:	FORT MYERS
State	:	FL
Zip	:	33967-5802
Country	:	US
Telephone Number	:	239-267-0887
Fax Number	:	239-267-0823

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

Provider Enumeration Date	:	01/17/2011
Last Update Date	:	01/17/2011

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