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6282 Dupont Station Ct E Ste 2 Jacksonville FL 32217-2515 | |
| (904) 900-3594 | |
| (904) 485-8760 |
| Full Name | |
|---|---|
| Speciality | Psychologist |
| Location | 6282 Dupont Station Ct E Ste 2, Jacksonville, Florida |
| Authorized Official Name and Position | Jessica Anderton (OWNER/PROVIDER) |
| Authorized Official Contact | 9049003594 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
6320 Saint Augustine Rd Ste 6a Jacksonville FL 32217-2813 Ph: (904) 900-3594 | 6282 Dupont Station Ct E Ste 2 Jacksonville FL 32217-2515 Ph: (904) 900-3594 |
| NPI Number | 1730574286 |
|---|---|
| Provider Enumeration Date | 04/01/2015 |
| Last Update Date | 04/18/2024 |
| Certification Date | 04/18/2024 |
| Medicare PECOS PAC ID | 6608141486 |
|---|---|
| Medicare Enrollment ID | O20171004001182 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730574286 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | PY7468 (Florida) | Primary |
| 103TC2200X | Psychologist - Clinical Child & Adolescent | (* (Not Available)) | Secondary |
| Provider Name | Jessica B Anderton |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1487812723 PECOS PAC ID: 4082885421 Enrollment ID: I20110915000623 |
| Provider Name | Lauriann Sandrik |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1205895968 PECOS PAC ID: 8628343845 Enrollment ID: I20171013000802 |
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