Provider Demographics
NPI:1942611413
Name:NANCY MARIE VRECHEK
Entity Type:Organization
Organization Name:NANCY MARIE VRECHEK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:VRECHEK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:561-747-3997
Mailing Address - Street 1:125 W INDIANTOWN RD
Mailing Address - Street 2:STE 203A
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-3556
Mailing Address - Country:US
Mailing Address - Phone:561-747-3997
Mailing Address - Fax:561-747-0258
Practice Address - Street 1:125 W INDIANTOWN RD
Practice Address - Street 2:STE 203A
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-3556
Practice Address - Country:US
Practice Address - Phone:561-747-3997
Practice Address - Fax:561-747-0258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-18
Last Update Date:2014-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY4538261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL73766OtherMEDICARE
FLPY4538OtherFLORIDA LICENSE