| Kent Island Psychological Services Inc | |
|
13180 N Cleveland Ave Suite 232 N Fort Myers FL 33903-6200 | |
| (239) 997-0700 | |
| (239) 997-0456 |
| Full Name | Kent Island Psychological Services Inc |
|---|---|
| Speciality | Psychologist |
| Location | 13180 N Cleveland Ave, N Fort Myers, Florida |
| Authorized Official Name and Position | Ronald Gerald Dalrymple (OWNER) |
| Authorized Official Contact | 2399970700 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kent Island Psychological Services Inc Po Box 4466 N Fort Myers FL 33918-4466 Ph: (239) 997-0700 | Kent Island Psychological Services Inc 13180 N Cleveland Ave Suite 232 N Fort Myers FL 33903-6200 Ph: (239) 997-0700 |
| NPI Number | 1518020957 |
|---|---|
| Provider Enumeration Date | 12/18/2006 |
| Last Update Date | 01/06/2017 |
| Medicare PECOS PAC ID | 7517988660 |
|---|---|
| Medicare Enrollment ID | O20051216000126 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518020957 | NPI | - | NPPES |
| 73032 | Other | FL | BC/BS |
| 11804019 | Other | FL | CAQH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | PY6631 (Florida) | Primary |
| Provider Name | Ronald G Dalrymple |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1629062112 PECOS PAC ID: 3870514920 Enrollment ID: I20110526000626 |
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