| Amber Fasula, Psy.d. | |
|
253 N Orlando Ave Ste 202 Maitland FL 32751-5521 | |
| (407) 790-4101 | |
| (407) 277-4400 |
| Full Name | Amber Fasula, Psy.d. |
|---|---|
| Speciality | Psychologist |
| Location | 253 N Orlando Ave Ste 202, Maitland, Florida |
| Authorized Official Name and Position | Amber L Fasula (OWNER) |
| Authorized Official Contact | 4077904101 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Amber Fasula, Psy.d. 253 N Orlando Ave Ste 202 Maitland FL 32751-5521 Ph: (407) 790-4101 | Amber Fasula, Psy.d. 253 N Orlando Ave Ste 202 Maitland FL 32751-5521 Ph: (407) 790-4101 |
| NPI Number | 1922474907 |
|---|---|
| Provider Enumeration Date | 08/13/2015 |
| Last Update Date | 04/24/2021 |
| Certification Date | 04/24/2021 |
| Medicare PECOS PAC ID | 9739420365 |
|---|---|
| Medicare Enrollment ID | O20190912002470 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922474907 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | PY9333 (Florida) | Primary |
| Provider Name | Amber Lee Fasula |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1730364472 PECOS PAC ID: 3375872526 Enrollment ID: I20190912003164 |
| Provider Name | Arturo Cintron |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1902046964 PECOS PAC ID: 3678996949 Enrollment ID: I20200702001889 |
| Provider Name | Laurie Kemper |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1700576899 PECOS PAC ID: 2668839572 Enrollment ID: I20230608001650 |
| Provider Name | Daniel Tellez |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1528687506 PECOS PAC ID: 8921458563 Enrollment ID: I20231222002033 |
| Provider Name | Stacey Herdegen |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1275275026 PECOS PAC ID: 0749625622 Enrollment ID: I20240301000807 |
Cmg- New Season- St. Louis Metro Treatment Center Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 2500 Maitland Center Parkway 250, Maitland, FL 32751 Phone: 407-351-7080 | |
Ana L. Gomez, Psy.d. P.a. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 202 Lookout Pl, Suite 100, Maitland, FL 32751 Phone: 407-927-8154 | |
Serenity Now Counseling Center, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1061 Maitland Center Commons Blvd, Suite 206, Maitland, FL 32751 Phone: 407-788-8600 | |
Jennifer Tickal, Psy.d., P.a. Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 1555 N Maitland Ave, Maitland, FL 32751 Phone: 813-563-5676 | |
The Bismillah Institute Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 2450 Maitland Center Pkwy Ste 202, Maitland, FL 32751 Phone: 786-432-5464 | |
Dna Comprehensive Therapy Services, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 100 E Sybelia Ave Ste 150, Maitland, FL 32751 Phone: 239-236-8784 Fax: 239-790-2624 | |
Blanche M Stokley, Lmhc P.a. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 225 S Swoope Ave Ste 205, Maitland, FL 32751 Phone: 407-691-0477 Fax: 407-691-0484 |