Provider Demographics
NPI:1205838935
Name:GORMAN, PATRICK W (PSYD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:W
Last Name:GORMAN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 N LAKEMONT AVE STE 2D
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-3217
Mailing Address - Country:US
Mailing Address - Phone:407-644-7792
Mailing Address - Fax:407-644-3509
Practice Address - Street 1:111 N LAKEMONT AVE STE 2D
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-3217
Practice Address - Country:US
Practice Address - Phone:407-644-7792
Practice Address - Fax:407-644-3509
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-12
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5141103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL59686OtherBLUE CROSS BLUE SHIELD
FL1051159OtherCIGNA BEHAVIORAL HEALTH
FLR85468Medicare UPIN
FL59686BMedicare PIN