Provider Demographics
NPI:1821027814
Name:PTASZEK, EMILY CATHERINE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:CATHERINE
Last Name:PTASZEK
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 1:6150 DIAMOND CENTRE CT
Mailing Address - Street 2:SUITE 1003
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-4365
Mailing Address - Country:US
Mailing Address - Phone:239-561-9955
Mailing Address - Fax:239-561-9779
Practice Address - Street 1:6150 DIAMOND CENTRE CT
Practice Address - Street 2:SUITE 1003
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4365
Practice Address - Country:US
Practice Address - Phone:239-561-9955
Practice Address - Fax:239-561-9779
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-02
Last Update Date:2008-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7057103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL74499OtherBC/BS OF FLORIDA
FL74499OtherMEDICARE