Provider Demographics
NPI:1497022875
Name:GERALD L TODOROFF, PSYD, PA
Entity Type:Organization
Organization Name:GERALD L TODOROFF, PSYD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:L
Authorized Official - Last Name:TODOROFF
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:352-597-5497
Mailing Address - Street 1:5465 COMMERCIAL WAY
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34606-1110
Mailing Address - Country:US
Mailing Address - Phone:352-597-5497
Mailing Address - Fax:
Practice Address - Street 1:5465 COMMERCIAL WAY
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34606-1110
Practice Address - Country:US
Practice Address - Phone:352-597-5497
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-29
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLS37931Medicare UPIN
FL54115Medicare PIN