Provider Demographics
NPI:1730143249
Name:LINDMEIER, VIRGINIA SAMANTHA (PSYD)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:SAMANTHA
Last Name:LINDMEIER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 N US HIGHWAY 441 STE 205
Mailing Address - Street 2:
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32159-4383
Mailing Address - Country:US
Mailing Address - Phone:352-787-2000
Mailing Address - Fax:
Practice Address - Street 1:117 N US HIGHWAY 441 STE 205
Practice Address - Street 2:
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-4383
Practice Address - Country:US
Practice Address - Phone:352-787-2000
Practice Address - Fax:352-787-2000
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-12
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7901103TC1900X
103TC2200X, 103TF0200X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL272312739OtherCIGNA
FL5931COtherBLUE CROSS BLUE SHEILD
FL765567300Medicaid
FL765567300Medicaid