Provider Demographics
NPI:1275214868
Name:ATLANTIC NEUROPSYCHOLOGY
Entity Type:Organization
Organization Name:ATLANTIC NEUROPSYCHOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR NEUROPSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:DELETTRE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:321-379-3799
Mailing Address - Street 1:2984 TUSCARORA CT
Mailing Address - Street 2:C/O JULIE L. DELETTRE, PSY.D.
Mailing Address - City:WEST MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-8098
Mailing Address - Country:US
Mailing Address - Phone:321-379-3799
Mailing Address - Fax:321-379-3790
Practice Address - Street 1:930 S HARBOR CITY BLVD STE 402
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-1967
Practice Address - Country:US
Practice Address - Phone:321-379-3799
Practice Address - Fax:321-379-3790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty