| Southwest Florida Psychological Services, Pllc | |
|
56 Manizaks Ave Punta Gorda FL 33983-4223 | |
| (941) 204-0059 | |
| Not Available |
| Full Name | Southwest Florida Psychological Services, Pllc |
|---|---|
| Speciality | Psychologist |
| Location | 56 Manizaks Ave, Punta Gorda, Florida |
| Authorized Official Name and Position | Brian C Olby (OWNER/DIRECTOR) |
| Authorized Official Contact | 9412040059 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southwest Florida Psychological Services, Pllc 56 Manizaks Ave Punta Gorda FL 33983-4223 Ph: (941) 204-0059 | Southwest Florida Psychological Services, Pllc 56 Manizaks Ave Punta Gorda FL 33983-4223 Ph: (941) 204-0059 |
| NPI Number | 1457594954 |
|---|---|
| Provider Enumeration Date | 04/13/2009 |
| Last Update Date | 03/04/2020 |
| Certification Date | 03/04/2020 |
| Medicare PECOS PAC ID | 2062567068 |
|---|---|
| Medicare Enrollment ID | O20090826000895 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457594954 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC1900X | Psychologist - Counseling | PY6434 (Florida) | Primary |
| Provider Name | Brian C Olby |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1770791873 PECOS PAC ID: 7517012511 Enrollment ID: I20090826000890 |
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