Provider Demographics
NPI:1235375387
Name:CENTRAL FLORIDA NEUROPSYCHOLOGY, LLC
Entity Type:Organization
Organization Name:CENTRAL FLORIDA NEUROPSYCHOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUM
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:866-488-1965
Mailing Address - Street 1:PO BOX 7365
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33872-0107
Mailing Address - Country:US
Mailing Address - Phone:866-448-1965
Mailing Address - Fax:888-242-1396
Practice Address - Street 1:4646 NADENA DR
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33872-1779
Practice Address - Country:US
Practice Address - Phone:866-448-1965
Practice Address - Fax:888-242-1396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-19
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103G00000X, 103TB0200X
FLPY6618251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty