| Andrea L Gockley Psy D | |
|
128 Orange Ave Daytona Beach FL 32114-4310 | |
| (386) 285-8978 | |
| Not Available |
| Full Name | Andrea L Gockley Psy D |
|---|---|
| Speciality | Psychologist |
| Location | 128 Orange Ave, Daytona Beach, Florida |
| Authorized Official Name and Position | Andrea Gockley (PRESIDENT) |
| Authorized Official Contact | 7064900810 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Andrea L Gockley Psy D 128 Orange Ave Daytona Beach FL 32114-4310 Ph: (386) 285-8978 | Andrea L Gockley Psy D 128 Orange Ave Daytona Beach FL 32114-4310 Ph: (386) 285-8978 |
| NPI Number | 1386356475 |
|---|---|
| Provider Enumeration Date | 12/20/2022 |
| Last Update Date | 02/06/2025 |
| Certification Date | 02/06/2025 |
| Medicare PECOS PAC ID | 9739550435 |
|---|---|
| Medicare Enrollment ID | O20230117000458 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386356475 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Andrea Gockley |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1902310295 PECOS PAC ID: 3971864760 Enrollment ID: I20180216002203 |
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