Provider Demographics
NPI:1184820029
Name:UNIVERSITY OF CENTRAL FLORIDA PSYCHOLOGY CLINIC
Entity Type:Organization
Organization Name:UNIVERSITY OF CENTRAL FLORIDA PSYCHOLOGY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT PROFESSOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:S
Authorized Official - Last Name:BEDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:407-823-5858
Mailing Address - Street 1:4000 CENTRAL FLORIDA BLVD
Mailing Address - Street 2:DEPARTMENT OF PSYCHOLOGY, UNIVERSITY OF CENTRAL FLORIDA
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32816-1390
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4000 CENTRAL FLORIDA BLVD
Practice Address - Street 2:DEPARTMENT OF PSYCHOLOGY, UNIVERSITY OF CENTRAL FLORIDA
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32816-1390
Practice Address - Country:US
Practice Address - Phone:407-823-4344
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)