| Lake Neurodiversity, Llc | |
|
711 W Main St Ste 127 Leesburg FL 34748-5128 | |
| (352) 460-1925 | |
| Not Available |
| Full Name | Lake Neurodiversity, Llc |
|---|---|
| Speciality | Psychologist - School |
| Location | 711 W Main St Ste 127, Leesburg, Florida |
| Authorized Official Name and Position | Susan Andrews (CO-OWNER, PSYCHOLOGIST) |
| Authorized Official Contact | 3523486989 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lake Neurodiversity, Llc 711 W Main St Ste 127 Leesburg FL 34748-5128 Ph: (352) 460-1925 | Lake Neurodiversity, Llc 711 W Main St Ste 127 Leesburg FL 34748-5128 Ph: (352) 460-1925 |
| NPI Number | 1790544658 |
|---|---|
| Provider Enumeration Date | 03/14/2024 |
| Last Update Date | 03/14/2024 |
| Certification Date | 03/14/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790544658 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TS0200X | Psychologist - School | (* (Not Available)) | Primary |
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