| Dr. Monica Lake, Pllc | |
|
10823 Boyette Rd Riverview FL 33569-8012 | |
| (813) 444-8760 | |
| Not Available |
| Full Name | Dr. Monica Lake, Pllc |
|---|---|
| Speciality | Psychologist |
| Location | 10823 Boyette Rd, Riverview, Florida |
| Authorized Official Name and Position | Monica Lake (OWNER) |
| Authorized Official Contact | 8134448760 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dr. Monica Lake, Pllc 10823 Boyette Rd Riverview FL 33569-8012 Ph: (813) 444-8760 | Dr. Monica Lake, Pllc 10823 Boyette Rd Riverview FL 33569-8012 Ph: (813) 444-8760 |
| NPI Number | 1427687011 |
|---|---|
| Provider Enumeration Date | 04/06/2020 |
| Last Update Date | 04/06/2020 |
| Certification Date | 04/06/2020 |
| Medicare PECOS PAC ID | 7113357286 |
|---|---|
| Medicare Enrollment ID | O20200414002084 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427687011 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Primary |
| Provider Name | Monica Lake |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1942745245 PECOS PAC ID: 4486084555 Enrollment ID: I20210416001039 |
| Provider Name | Carolyne Cole |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1295367001 PECOS PAC ID: 3678925021 Enrollment ID: I20240122001566 |
| Provider Name | Jo-anne Ballard |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1265109649 PECOS PAC ID: 8426496977 Enrollment ID: I20240403003020 |
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