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9702 Universal Blvd B-325 Orlando FL 32819-8721 | |
| (470) 505-9158 | |
| (866) 480-9482 |
| Full Name | |
|---|---|
| Speciality | Psychologist |
| Location | 9702 Universal Blvd, Orlando, Florida |
| Authorized Official Name and Position | Alfred Dean Vonetes (PRESIDENT/CEO) |
| Authorized Official Contact | 4075059158 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
9702 Universal Blvd B-325 Orlando FL 32819-8721 Ph: (470) 505-9158 | 9702 Universal Blvd B-325 Orlando FL 32819-8721 Ph: (470) 505-9158 |
| NPI Number | 1336553817 |
|---|---|
| Provider Enumeration Date | 06/12/2014 |
| Last Update Date | 06/12/2014 |
| Medicare PECOS PAC ID | 9638492192 |
|---|---|
| Medicare Enrollment ID | O20150108001568 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336553817 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | PY 8996 (Florida) | Primary |
| 103TC2200X | Psychologist - Clinical Child & Adolescent | PY 8996 (Florida) | Secondary |
| Provider Name | Alfred Dean Vonetes |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1326452897 PECOS PAC ID: 5193942381 Enrollment ID: I20140812001552 |
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