| Stephen E Nassar Psy D Lcsw P A | |
|
3684 N Wickham Rd Suite B Melbourne FL 32935-2328 | |
| (321) 751-3636 | |
| (321) 751-8108 |
| Full Name | Stephen E Nassar Psy D Lcsw P A |
|---|---|
| Speciality | Psychologist |
| Location | 3684 N Wickham Rd, Melbourne, Florida |
| Authorized Official Name and Position | Stephen Edward Nassar (CEO) |
| Authorized Official Contact | 3217513636 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Stephen E Nassar Psy D Lcsw P A 3684 N Wickham Rd Suite B Melbourne FL 32935-2328 Ph: (321) 751-3636 | Stephen E Nassar Psy D Lcsw P A 3684 N Wickham Rd Suite B Melbourne FL 32935-2328 Ph: (321) 751-3636 |
| NPI Number | 1659305571 |
|---|---|
| Provider Enumeration Date | 07/10/2006 |
| Last Update Date | 10/26/2011 |
| Medicare PECOS PAC ID | 7618902370 |
|---|---|
| Medicare Enrollment ID | O20050930000419 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659305571 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | PY6228 (Florida) | Primary |
| 1041C0700X | Social Worker - Clinical | SW3802 (Florida) | Secondary |
| Provider Name | Stephen E Nassar |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1790703973 PECOS PAC ID: 1153356811 Enrollment ID: I20111214000563 |
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