Doctor Name: | AMY WALDIE |
NPI Number: | 1144613258 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | MH 13228 |
Business Practice Address: | 1217 Huffstetler Rd Eustis, FL - 327268225 |
Business Phone Number: | 3524831652 |
Business Fax Number: | 3523606582 |
Mailing Address: | 6009 Pine Bluff Ln, MASCOTTE |
State: | FL |
Postal Code: | 347538882 |
Phone Number: | 3524088644 |
Fax Number: | |
NPI Enumeration Date: | 03/13/2015 |
NPI Last Update Date: | 03/13/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | MH 13228 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |