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4700 Millenia Blvd Ste 175 Orlando FL 32839-6015 | |
| (407) 595-0900 | |
| (866) 480-9482 |
| Full Name | |
|---|---|
| Speciality | Psychologist |
| Location | 4700 Millenia Blvd Ste 175, Orlando, Florida |
| Authorized Official Name and Position | Dean Alfred Vonetes (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 4075950900 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
4700 Millenia Blvd Ste 175 Orlando FL 32839-6015 Ph: (407) 595-0900 | 4700 Millenia Blvd Ste 175 Orlando FL 32839-6015 Ph: (407) 595-0900 |
| NPI Number | 1932602455 |
|---|---|
| Provider Enumeration Date | 03/11/2018 |
| Last Update Date | 02/08/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932602455 | NPI | - | NPPES |
| G18000032780 | Other | FICTITIOUS NAME REGISTRATION NUMBER | |
| P18000022056 | Other | FL | CORPORATION NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | 7432489 (Florida) | Secondary |
| 103T00000X | Psychologist | 7000371 (Florida) | Primary |
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