MEDICARE: DR. PATRICK W GORMAN PSYD

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	103G00000X	Clinical Neuropsychologist	PY5141	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	59686	OTHER	FL	BLUE CROSS BLUE SHIELD
2	1051159	OTHER	FL	CIGNA BEHAVIORAL HEALTH

General Provider Information

NPI Number	:	1205838935
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICK W GORMAN PSYD

Provider Business Mailing Address
First Line	:	111 N LAKEMONT AVE STE 2D
Second Line	:
City	:	WINTER PARK
State	:	FL
Zip	:	32792-3217
Country	:	US
Telephone Number	:	407-644-7792
Fax Number	:	407-644-3509

Provider Business Practice Location Address
First Line	:	111 N LAKEMONT AVE STE 2D
Second Line	:
City	:	WINTER PARK
State	:	FL
Zip	:	32792-3217
Country	:	US
Telephone Number	:	407-644-7792
Fax Number	:	407-644-3509

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

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	03/04/2019

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