Provider Demographics
NPI:1891131637
Name:PRIMARY PSYCHOLOGY OF CENTRAL FLORIDA, LLC
Entity Type:Organization
Organization Name:PRIMARY PSYCHOLOGY OF CENTRAL FLORIDA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:YAMILA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:407-900-4885
Mailing Address - Street 1:2521 13TH ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34769-4119
Mailing Address - Country:US
Mailing Address - Phone:407-900-4885
Mailing Address - Fax:866-515-9293
Practice Address - Street 1:2521 13TH ST
Practice Address - Street 2:SUITE F
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-4119
Practice Address - Country:US
Practice Address - Phone:407-900-4885
Practice Address - Fax:866-515-9293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-20
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty