| Thomas F. Guidera, Ph.d, P.a. | |
|
1777 Garden Street Titusville FL 32796-3221 | |
| (321) 268-5682 | |
| (321) 268-5683 |
| Full Name | Thomas F. Guidera, Ph.d, P.a. |
|---|---|
| Speciality | Psychologist |
| Location | 1777 Garden Street, Titusville, Florida |
| Authorized Official Name and Position | Thomas F Guidera (OWNER-PRACTITIONER) |
| Authorized Official Contact | 3212685682 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Thomas F. Guidera, Ph.d, P.a. 1777 Garden Street Titusville FL 32796-3221 Ph: (321) 268-5682 | Thomas F. Guidera, Ph.d, P.a. 1777 Garden Street Titusville FL 32796-3221 Ph: (321) 268-5682 |
| NPI Number | 1013202571 |
|---|---|
| Provider Enumeration Date | 06/13/2011 |
| Last Update Date | 05/15/2012 |
| Medicare PECOS PAC ID | 9133382112 |
|---|---|
| Medicare Enrollment ID | O20120601000077 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013202571 | NPI | - | NPPES |
| 1770647810 | Other | CURRENT NPI | |
| 75434 | Other | MEDICARE PTAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | PY 3165 (Florida) | Secondary |
| 103TC0700X | Psychologist - Clinical | PY0003165 (Florida) | Primary |
| Provider Name | Thomas F Guidera |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1770647810 PECOS PAC ID: 4587827563 Enrollment ID: I20120601000147 |
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