Provider Demographics
NPI:1841418456
Name:PRICKETT, JEFFREY LEE (PSYD, AP)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:LEE
Last Name:PRICKETT
Suffix:
Gender:M
Credentials:PSYD, AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 697
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32790-0697
Mailing Address - Country:US
Mailing Address - Phone:407-414-1380
Mailing Address - Fax:
Practice Address - Street 1:2180 N PARK AVE
Practice Address - Street 2:#326
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-2359
Practice Address - Country:US
Practice Address - Phone:407-644-3593
Practice Address - Fax:407-644-1713
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-22
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 3938103TC0700X
FLAP 628171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No171100000XOther Service ProvidersAcupuncturist