Provider Demographics
NPI:1639379928
Name:FLORIDA PSYCHOLOGICAL SPECIALISTS
Entity Type:Organization
Organization Name:FLORIDA PSYCHOLOGICAL SPECIALISTS
Other - Org Name:DEMARA BENNETT SOLE MBR
Other - Org Type:Other Name
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DEMARA
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:321-777-4440
Mailing Address - Street 1:1127 S PATRICK DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SATELLITE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-3939
Mailing Address - Country:US
Mailing Address - Phone:321-777-4440
Mailing Address - Fax:321-777-4440
Practice Address - Street 1:1127 S PATRICK DR
Practice Address - Street 2:SUITE 1
Practice Address - City:SATELLITE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32937-3939
Practice Address - Country:US
Practice Address - Phone:321-777-4440
Practice Address - Fax:321-777-4440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 7342103G00000X, 103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty