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1950 Lee Rd Suite 202 Winter Park FL 32789-1859 | |
| (407) 739-5874 | |
| (407) 644-1292 |
| Full Name | |
|---|---|
| Speciality | Psychologist - Clinical Child & Adolescent |
| Location | 1950 Lee Rd, Winter Park, Florida |
| Authorized Official Name and Position | Robert C Coolidge (AGENT/REPRESENTATIVE) |
| Authorized Official Contact | 3867745211 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 741240 Orange City FL 32774-1240 Ph: (386) 774-5211 | 1950 Lee Rd Suite 202 Winter Park FL 32789-1859 Ph: (407) 739-5874 |
| NPI Number | 1306039243 |
|---|---|
| Provider Enumeration Date | 08/23/2007 |
| Last Update Date | 04/20/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306039243 | NPI | - | NPPES |
| 54725 | Other | FL | FL BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC2200X | Psychologist - Clinical Child & Adolescent | PY6399 (Florida) | Primary |
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