Provider Demographics
NPI:1912393349
Name:LUNDEN PSYCHOLOGICAL SERVICES, INC.
Entity Type:Organization
Organization Name:LUNDEN PSYCHOLOGICAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:CAROL
Authorized Official - Last Name:LUNDEN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:727-240-1922
Mailing Address - Street 1:9160 OAKHURST RD
Mailing Address - Street 2:SUITE 3B
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33776-2157
Mailing Address - Country:US
Mailing Address - Phone:727-240-1922
Mailing Address - Fax:727-240-1928
Practice Address - Street 1:9160 OAKHURST RD
Practice Address - Street 2:SUITE 3B
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33776-2157
Practice Address - Country:US
Practice Address - Phone:727-240-1922
Practice Address - Fax:727-240-1928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-13
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY9206103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014703800Medicaid