Provider Demographics
NPI:1336490093
Name:FLORIDA NEUROPSYCHOLOGY
Entity Type:Organization
Organization Name:FLORIDA NEUROPSYCHOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEUROPSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:CARREO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:727-204-8318
Mailing Address - Street 1:3951 SERENADE LN
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33811-8603
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1501 S ALEXANDER ST
Practice Address - Street 2:SUITE 104
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-8408
Practice Address - Country:US
Practice Address - Phone:727-204-8318
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-20
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8596103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty