Provider Demographics
NPI:1548741705
Name:EMERY MILNE PSYCHOLOGICAL GROUP, LLC
Entity Type:Organization
Organization Name:EMERY MILNE PSYCHOLOGICAL GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MILNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-270-4040
Mailing Address - Street 1:165 WELLS RD STE 304
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-3037
Mailing Address - Country:US
Mailing Address - Phone:904-720-4040
Mailing Address - Fax:904-720-4596
Practice Address - Street 1:165 WELLS RD STE 304
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-3037
Practice Address - Country:US
Practice Address - Phone:904-720-4040
Practice Address - Fax:904-720-4596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-27
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY9283103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty