Provider Demographics
NPI:1689922528
Name:GREGORY VAN DAM, PSY.D. LLC
Entity Type:Organization
Organization Name:GREGORY VAN DAM, PSY.D. LLC
Other - Org Name:COMPREHENSIVE PSYCHOLOGY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN DAM
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:561-252-7336
Mailing Address - Street 1:1936 LEE RD
Mailing Address - Street 2:SUITE 290
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-7229
Mailing Address - Country:US
Mailing Address - Phone:407-233-1864
Mailing Address - Fax:407-563-3264
Practice Address - Street 1:1936 LEE RD
Practice Address - Street 2:SUITE 290
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-7229
Practice Address - Country:US
Practice Address - Phone:407-233-1864
Practice Address - Fax:407-563-3264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-27
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 8572103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty