Provider Demographics
NPI:1972000123
Name:BRITTA BOEKAMP PSY D LLC
Entity Type:Organization
Organization Name:BRITTA BOEKAMP PSY D LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:BRITTA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOEKAMP
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, LP
Authorized Official - Phone:407-494-9436
Mailing Address - Street 1:335 N MAGNOLIA AVE APT 507
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-1770
Mailing Address - Country:US
Mailing Address - Phone:952-412-6824
Mailing Address - Fax:
Practice Address - Street 1:870 CLARK ST STE 1030
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-9270
Practice Address - Country:US
Practice Address - Phone:407-494-9436
Practice Address - Fax:407-369-4193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-12
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherIRS