Provider Demographics
NPI:1073052205
Name:ARAGON PSYCHOLOGICAL SERVICES, LLC
Entity Type:Organization
Organization Name:ARAGON PSYCHOLOGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:ARAGON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:321-327-3793
Mailing Address - Street 1:3605 BURDOCK AVE
Mailing Address - Street 2:
Mailing Address - City:W MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-7526
Mailing Address - Country:US
Mailing Address - Phone:352-406-8966
Mailing Address - Fax:
Practice Address - Street 1:122 4TH AVE STE 200
Practice Address - Street 2:
Practice Address - City:INDIALANTIC
Practice Address - State:FL
Practice Address - Zip Code:32903-3112
Practice Address - Country:US
Practice Address - Phone:321-327-3793
Practice Address - Fax:321-327-7914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-21
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY9193103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty