Provider Demographics
NPI:1033272133
Name:CENTRAL FLORIDA PSYCHOLOGICAL SER INC
Entity Type:Organization
Organization Name:CENTRAL FLORIDA PSYCHOLOGICAL SER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:CHERIE
Authorized Official - Last Name:SULT
Authorized Official - Suffix:
Authorized Official - Credentials:PH D
Authorized Official - Phone:407-330-0418
Mailing Address - Street 1:PO BOX 2524
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32772-2524
Mailing Address - Country:US
Mailing Address - Phone:407-330-0418
Mailing Address - Fax:407-321-0059
Practice Address - Street 1:204 N PARK AVE STE 100
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-1293
Practice Address - Country:US
Practice Address - Phone:407-330-0418
Practice Address - Fax:407-321-0059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 3854103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAB649Medicare UPIN
FL73245Medicare ID - Type Unspecified