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501 Goodlette-frank Rd N Ste C206 Naples FL 34102-5666 | |
| (239) 289-9796 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Psychologist |
| Location | 501 Goodlette-frank Rd N Ste C206, Naples, Florida |
| Authorized Official Name and Position | Jennifer Jankowski (DIRECTOR OF OPERATIONS) |
| Authorized Official Contact | 2392899796 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
501 Goodlette-frank Rd N Ste C206 Naples FL 34102-5666 Ph: (239) 289-9796 | 501 Goodlette-frank Rd N Ste C206 Naples FL 34102-5666 Ph: (239) 289-9796 |
| NPI Number | 1861094351 |
|---|---|
| Provider Enumeration Date | 11/10/2020 |
| Last Update Date | 10/03/2024 |
| Certification Date | 10/03/2024 |
| Medicare PECOS PAC ID | 9133533789 |
|---|---|
| Medicare Enrollment ID | O20210122001312 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861094351 | NPI | - | NPPES |
| Provider Name | Stephanie Marie Roque Midoneck |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1366971673 PECOS PAC ID: 7113254830 Enrollment ID: I20190802002680 |
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