| Amber Fasula, Psy.d. | |
|
253 N Orlando Ave Ste 202 Maitland FL 32751-5521 | |
| (407) 790-4101 | |
| (407) 277-4400 |
| Full Name | Amber Fasula, Psy.d. |
|---|---|
| Speciality | Psychologist |
| Location | 253 N Orlando Ave Ste 202, Maitland, Florida |
| Authorized Official Name and Position | Amber L Fasula (OWNER) |
| Authorized Official Contact | 4077904101 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Amber Fasula, Psy.d. 253 N Orlando Ave Ste 202 Maitland FL 32751-5521 Ph: (407) 790-4101 | Amber Fasula, Psy.d. 253 N Orlando Ave Ste 202 Maitland FL 32751-5521 Ph: (407) 790-4101 |
| NPI Number | 1922474907 |
|---|---|
| Provider Enumeration Date | 08/13/2015 |
| Last Update Date | 04/24/2021 |
| Certification Date | 04/24/2021 |
| Medicare PECOS PAC ID | 9739420365 |
|---|---|
| Medicare Enrollment ID | O20190912002470 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922474907 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | PY9333 (Florida) | Primary |
| Provider Name | Julia M Salmon |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1619409463 PECOS PAC ID: 3779860887 Enrollment ID: I20170427000919 |
| Provider Name | Amber Lee Fasula |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1730364472 PECOS PAC ID: 3375872526 Enrollment ID: I20190912003164 |
| Provider Name | Arturo Cintron |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1902046964 PECOS PAC ID: 3678996949 Enrollment ID: I20200702001889 |
| Provider Name | Laurie Kemper |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1700576899 PECOS PAC ID: 2668839572 Enrollment ID: I20230608001650 |
| Provider Name | Daniel Tellez |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1528687506 PECOS PAC ID: 8921458563 Enrollment ID: I20231222002033 |
| Provider Name | Stacey Herdegen |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1275275026 PECOS PAC ID: 0749625622 Enrollment ID: I20240301000807 |
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