MEDICARE: JAMES NOVEMBER PHD

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	PY2480	FL

General Provider Information

NPI Number	:	1336250083
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES NOVEMBER PHD

Provider Business Mailing Address
First Line	:	647 BEACH AVE
Second Line	:
City	:	ATLANTIC BEACH
State	:	FL
Zip	:	32233-5325
Country	:	US
Telephone Number	:	904-256-7231
Fax Number	:	630-604-2468

Provider Business Practice Location Address
First Line	:	4400 MARSH LANDING BLVD
Second Line	:	SUITE 6
City	:	PONTE VEDRA BEACH
State	:	FL
Zip	:	32082-1287
Country	:	US
Telephone Number	:	904-256-7231
Fax Number	:	630-604-2468

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	11/06/2015

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