Provider Demographics
NPI:1861475881
Name:ATWATER, J MICHAEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:J MICHAEL
Middle Name:
Last Name:ATWATER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4362 NORTHLAKE BLVD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-6275
Mailing Address - Country:US
Mailing Address - Phone:561-694-1887
Mailing Address - Fax:561-626-2131
Practice Address - Street 1:4362 NORTHLAKE BLVD
Practice Address - Street 2:SUITE 108
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-6275
Practice Address - Country:US
Practice Address - Phone:561-694-1887
Practice Address - Fax:561-626-2131
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-23
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0003419103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist