Doctor Name: | DR. PAULA DEFOREST |
NPI Number: | 1306081179 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PHD |
License Number: | PY0004766 |
Business Practice Address: | 2020 Commerce Dr West Melbourne, FL - 329042335 |
Business Phone Number: | 3219526000 |
Business Fax Number: | |
Mailing Address: | 2290 Rockledge Dr, ROCKLEDGE |
State: | FL |
Postal Code: | 329555404 |
Phone Number: | 3213055068 |
Fax Number: | |
NPI Enumeration Date: | 12/09/2008 |
NPI Last Update Date: | 09/29/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC2200X |
License Number: | PY0004766 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical Child & Adolescent |
Taxonomy Definition: |