Individual Provider
Individual Provider is a Community/Behavioral Health Agency in Longwood, Florida. Licensed in Florida. Registered with an NPI since 2015.
- Licensed in
- FL
- In the registry since
- 2015
Practice location Address checks out
650 Palermo Vista CtLongwood, FL 32750-3419
Phone: (317) 697-8932
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Pin is approximate — placed at the ZIP-code centre, not the exact door.
Specialties & licences
| Community/Behavioral Health Agency (primary) | Taxonomy 251S00000X · Licence ISW10093 (FL) |
|---|
Record details
| NPI number | 1033587795 |
|---|---|
| Entity type | Organization (Type 2) |
| Organization subpart | No |
| Authorized official | Christine Garry — Master'S Level Contract Clinician · (317) 697-8932 |
| NPI enumerated | September 10, 2015 |
| Last updated in NPPES | September 10, 2015 |
| Mailing address | 650 Palermo Vista Ct, Longwood, FL 32750-3419 |
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