Provider Demographics
NPI:1568763944
Name:GEORGE MEDZERIAN PH.D. INC.
Entity Type:Organization
Organization Name:GEORGE MEDZERIAN PH.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDZERIAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:772-485-0235
Mailing Address - Street 1:428 SW 7TH ST
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-2908
Mailing Address - Country:US
Mailing Address - Phone:772-283-0013
Mailing Address - Fax:772-219-4785
Practice Address - Street 1:428 SW 7TH ST
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2908
Practice Address - Country:US
Practice Address - Phone:772-283-0013
Practice Address - Fax:772-219-4785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-16
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY3086103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFL2095OtherBRADMAN
089002OtherVALUE OPTIONS
5371572OtherAETNA
75859OtherBLUE CROSS BLUE SHIELD
215000OtherPHCS
5371572OtherAETNA