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NPI Code Detail

MEDICARE: PSYCHOLOGICAL ASSOCIATES OF MELBOURNE, INC.

MEDICARE: PSYCHOLOGICAL ASSOCIATES OF MELBOURNE, INC.
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
1103T00000XPsychologistPY 7426FL
2103TC0700XClinical Psychologist

General Provider Information

NPI Number : 1851618771
Entity Type Code : Organization
Provider Name (Legal Business Name) : PSYCHOLOGICAL ASSOCIATES OF MELBOURNE, INC.
Provider Business Mailing Address
First Line : 200 N PALM AVE UNIT 33850
Second Line :
City : INDIALANTIC
State : FL
Zip : 32903-5034
Country : US
Telephone Number : 321-541-1250
Fax Number : 321-951-1928
Provider Business Practice Location Address
First Line : 1825 RIVERVIEW DR
Second Line :
City : MELBOURNE
State : FL
Zip : 32901-4711
Country : US
Telephone Number : 321-541-1250
Fax Number : 321-951-1928
Authorized Official
Title or Position : PRESIDENT
Name : DR. WENDE J ANDERSON
Credential : PSYD
Telephone Number : 321-541-1250
Provider Enumeration Date : 05/03/2010
Last Update Date : 02/26/2023

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