| Organization Name: | CLINICAL PSYCHOLOGY PROFESSIONAL CENTER LLC |
| NPI Number: | 1619297041 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | GABRIELA CINTIA LODEIRO (SOLE PROPRIETOR) |
| Mailing Address: | 738 N Macewen Dr Osprey |
| State: | FL US |
| Postal Code: | 342293200 |
| Phone Number: | 8133346222 |
| Fax Number: | 9419660887 |
| NPI Enumeration Date: | 06/08/2010 |
| NPI Last Update Date: | 07/07/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QM0850X |
| License Number: | PY8074 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Adult Mental Health |
| Taxonomy Definition: | An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in adults. |