| Lake Neurodiversity, Llc | |
|
117 N 7th St Leesburg FL 34748-5115 | |
| (352) 460-1925 | |
| Not Available |
| Full Name | Lake Neurodiversity, Llc |
|---|---|
| Speciality | Psychologist - School |
| Location | 117 N 7th St, Leesburg, Florida |
| Authorized Official Name and Position | Susan M Andrews (CO-OWNER) |
| Authorized Official Contact | 3524601925 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lake Neurodiversity, Llc 12501 Lake Ridge Cir Clermont FL 34711-8585 Ph: (352) 460-1925 | Lake Neurodiversity, Llc 117 N 7th St Leesburg FL 34748-5115 Ph: (352) 460-1925 |
| NPI Number | 1659157428 |
|---|---|
| Provider Enumeration Date | 09/06/2023 |
| Last Update Date | 09/06/2023 |
| Certification Date | 09/06/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659157428 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TS0200X | Psychologist - School | (* (Not Available)) | Primary |
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