| Psychological And Neurobehavioral Services P A | |
|
4720 Cleveland Heights Blvd Suite 105 Lakeland FL 33813-2243 | |
| (863) 701-9202 | |
| (863) 701-9262 |
| Full Name | Psychological And Neurobehavioral Services P A |
|---|---|
| Speciality | Clinical Neuropsychologist |
| Location | 4720 Cleveland Heights Blvd, Lakeland, Florida |
| Authorized Official Name and Position | Tracey G. Henley (PRESIDENT) |
| Authorized Official Contact | 8637019202 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Psychological And Neurobehavioral Services P A 4720 Cleveland Heights Blvd Suite 105 Lakeland FL 33813-2243 Ph: (863) 701-9202 | Psychological And Neurobehavioral Services P A 4720 Cleveland Heights Blvd Suite 105 Lakeland FL 33813-2243 Ph: (863) 701-9202 |
| NPI Number | 1528127081 |
|---|---|
| Provider Enumeration Date | 12/08/2006 |
| Last Update Date | 06/05/2008 |
| Medicare PECOS PAC ID | 5991720054 |
|---|---|
| Medicare Enrollment ID | O20051008000055 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528127081 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103G00000X | Clinical Neuropsychologist | (* (Not Available)) | Primary |
| Provider Name | Tracey G Henley |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1528129038 PECOS PAC ID: 1355366410 Enrollment ID: I20080111000020 |
| Provider Name | Suzanne Marie Lavelle |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1952594806 PECOS PAC ID: 4587821640 Enrollment ID: I20120201000960 |
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