MEDICARE: DR. VERED DOR PSY.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	103TC0700X	Clinical Psychologist	071007907	IL
2	103TC0700X	Clinical Psychologist	PY10806	FL

General Provider Information

NPI Number	:	1730479916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VERED DOR PSY.D.

Provider Business Mailing Address
First Line	:	9230 HECKSCHER DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32226-2417
Country	:	US
Telephone Number	:	847-980-8707
Fax Number	:

Provider Business Practice Location Address
First Line	:	14333 BEACH BLVD STE 33
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32250-1573
Country	:	US
Telephone Number	:	847-980-8707
Fax Number	:

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

Provider Enumeration Date	:	04/09/2011
Last Update Date	:	09/08/2020

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