Provider Demographics
NPI:1851618771
Name:PSYCHOLOGICAL ASSOCIATES OF MELBOURNE, INC.
Entity Type:Organization
Organization Name:PSYCHOLOGICAL ASSOCIATES OF MELBOURNE, INC.
Other - Org Name:WENDE J ANDERSON PSYD PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WENDE
Authorized Official - Middle Name:J
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:321-541-1250
Mailing Address - Street 1:200 N PALM AVE UNIT 33850
Mailing Address - Street 2:
Mailing Address - City:INDIALANTIC
Mailing Address - State:FL
Mailing Address - Zip Code:32903-5034
Mailing Address - Country:US
Mailing Address - Phone:321-541-1250
Mailing Address - Fax:321-951-1928
Practice Address - Street 1:1825 RIVERVIEW DR
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-4711
Practice Address - Country:US
Practice Address - Phone:321-541-1250
Practice Address - Fax:321-951-1928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-03
Last Update Date:2023-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 7426103T00000X
103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty