Provider Demographics
NPI:1629477203
Name:BOEKAMP, BRITTA (PSYD LLC)
Entity Type:Individual
Prefix:DR
First Name:BRITTA
Middle Name:
Last Name:BOEKAMP
Suffix:
Gender:F
Credentials:PSYD LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 N MAGNOLIA AVE
Mailing Address - Street 2:APT 507
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801
Mailing Address - Country:US
Mailing Address - Phone:952-412-6824
Mailing Address - Fax:
Practice Address - Street 1:870 CLARK ST STE 1030
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-9270
Practice Address - Country:US
Practice Address - Phone:407-494-9436
Practice Address - Fax:407-369-4193
Is Sole Proprietor?:No
Enumeration Date:2014-08-19
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
FLPY9678103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
82-0819699OtherIRS