Provider Demographics
NPI:1518339944
Name:FLORIDA PSYCHOLOGY CENTER, LLC
Entity Type:Organization
Organization Name:FLORIDA PSYCHOLOGY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOCCO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:201-484-9383
Mailing Address - Street 1:8819 MINNOW CREEK DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32312-5041
Mailing Address - Country:US
Mailing Address - Phone:201-484-9383
Mailing Address - Fax:
Practice Address - Street 1:1030 E LAFAYETTE ST STE 8
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-4547
Practice Address - Country:US
Practice Address - Phone:201-484-9383
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-25
Last Update Date:2015-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY9289103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty