MEDICARE: MS. EILEEN KRIMSKY 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	PY3475	FL

General Provider Information

NPI Number	:	1730159831
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. EILEEN KRIMSKY PH.D.

Provider Business Mailing Address
First Line	:	14011 BEACH BLVD
Second Line	:	SUITE 100
City	:	JACKSONVILLE
State	:	FL
Zip	:	32250-1507
Country	:	US
Telephone Number	:	904-223-4865
Fax Number	:	904-223-4868

Provider Business Practice Location Address
First Line	:	14011 BEACH BLVD
Second Line	:	SUITE 100
City	:	JACKSONVILLE
State	:	FL
Zip	:	32250-1507
Country	:	US
Telephone Number	:	904-223-4865
Fax Number	:	904-223-4868

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

Provider Enumeration Date	:	01/23/2006
Last Update Date	:	04/01/2008

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