Provider Demographics
NPI:1013155498
Name:WINTER PARK PSYCHOLOGY, INC.
Entity Type:Organization
Organization Name:WINTER PARK PSYCHOLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GABRIELA
Authorized Official - Middle Name:F
Authorized Official - Last Name:OTT
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:321-604-7024
Mailing Address - Street 1:925 BONITA DR
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-2721
Mailing Address - Country:US
Mailing Address - Phone:321-604-7024
Mailing Address - Fax:
Practice Address - Street 1:701 W MORSE BLVD
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-3794
Practice Address - Country:US
Practice Address - Phone:321-604-7024
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-23
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7273103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty