| Individual Provider | |
|
650 Palermo Vista Ct Longwood FL 32750-3419 | |
| (317) 697-8932 | |
| Not Available |
| Full Name | Individual Provider |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 650 Palermo Vista Ct, Longwood, Florida |
| Authorized Official Name and Position | Christine Marie Garry (MASTER'S LEVEL CONTRACT CLINICIAN) |
| Authorized Official Contact | 3176978932 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Individual Provider 650 Palermo Vista Ct Longwood FL 32750-3419 Ph: (317) 697-8932 | Individual Provider 650 Palermo Vista Ct Longwood FL 32750-3419 Ph: (317) 697-8932 |
| NPI Number | 1033587795 |
|---|---|
| Provider Enumeration Date | 09/10/2015 |
| Last Update Date | 09/10/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033587795 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | ISW10093 (Florida) | Primary |
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