MEDICARE: DENISE P FEDERER 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	103T00000X	Psychologist	PY3573	FL

General Provider Information

NPI Number	:	1720114762
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENISE P FEDERER PH.D.

Provider Business Mailing Address
First Line	:	3641 W KENNEDY BLVD
Second Line	:	SUITE G
City	:	TAMPA
State	:	FL
Zip	:	33609-2851
Country	:	US
Telephone Number	:	813-876-7191
Fax Number	:	813-876-9008

Provider Business Practice Location Address
First Line	:	3641 W KENNEDY BLVD
Second Line	:	SUITE G
City	:	TAMPA
State	:	FL
Zip	:	33609-2851
Country	:	US
Telephone Number	:	813-876-7191
Fax Number	:	813-876-9008

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

Provider Enumeration Date	:	02/26/2007
Last Update Date	:	07/08/2007

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