Provider Demographics
NPI:1366454308
Name:AET OF CENTRAL FLORIDA OF SCHAEFFER & HENDERSON, P.A.
Entity Type:Organization
Organization Name:AET OF CENTRAL FLORIDA OF SCHAEFFER & HENDERSON, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:352-732-3333
Mailing Address - Street 1:PO BOX 2854
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34478-2854
Mailing Address - Country:US
Mailing Address - Phone:352-732-3333
Mailing Address - Fax:352-732-2469
Practice Address - Street 1:1515 E SILVER SPRINGS BLVD
Practice Address - Street 2:SUITE 112
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34470-6831
Practice Address - Country:US
Practice Address - Phone:352-732-3333
Practice Address - Fax:352-732-2469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL24184OtherBCBS OF FLORIDA
FL24184Medicare ID - Type Unspecified