MEDICARE: DR. JEFFREY LEE PRICKETT PSY.D., AP

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	PY 3938	FL
2	171100000X	Acupuncturist	AP 628	FL

General Provider Information

NPI Number	:	1841418456
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY LEE PRICKETT PSY.D., AP

Provider Business Mailing Address
First Line	:	PO BOX 697
Second Line	:
City	:	WINTER PARK
State	:	FL
Zip	:	32790-0697
Country	:	US
Telephone Number	:	407-414-1380
Fax Number	:

Provider Business Practice Location Address
First Line	:	2180 N PARK AVE
Second Line	:	#326
City	:	WINTER PARK
State	:	FL
Zip	:	32789-2359
Country	:	US
Telephone Number	:	407-644-3593
Fax Number	:	407-644-1713

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

Provider Enumeration Date	:	04/22/2007
Last Update Date	:	03/20/2017

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