Provider Demographics
NPI:1841275674
Name:WESTERVELD, MICHAEL (PHD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:WESTERVELD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 E PRINCETON ST STE 540
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-1424
Mailing Address - Country:US
Mailing Address - Phone:407-303-8877
Mailing Address - Fax:407-303-8811
Practice Address - Street 1:615 E PRINCETON ST STE 540
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-1424
Practice Address - Country:US
Practice Address - Phone:407-303-8877
Practice Address - Fax:407-303-8811
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001601103G00000X, 103TC0700X
FLPY7661103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004107745Medicaid
CT680000093OtherMEDICARE CT
10320722Medicare UPIN