Andrea G Dertany PSYD
Organization Active NPI Psychologist · Indialantic, FL
NPI 1104238294 · NPPES record last updated May 23, 2014
Key facts
- NPI
- 1104238294
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Psychologist 103T00000X
- License
- PY4374 (FL)
- Legal business name
- ANDREA G DERTANY PSYD
- Practice address
- 105 S Riverside Dr Ste 130
Indialantic, FL 32903-4321 - Phone
- (321) 727-9031
- Fax
- (321) 724-8011
- NPI assigned
- May 23, 2014
- Organization subpart
- No
Authorized official
- Name
- Beckie Reel
- Title
- Admin Assistant
- Phone
- (321) 727-9031
National Provider Directory
Locations
105 S Riverside Dr
Ste 130
Indialantic, FL 32903
Phone (321) 727-9031
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist |
103T00000X | PY4374 | FL | Yes |
Addresses
Primary practice location
105 S Riverside Dr Ste 130
Indialantic, FL 32903-4321
Mailing address
105 S Riverside Dr Ste 130
Indialantic, FL 32903-4321
Phone (321) 727-9031
Other providers in Indialantic, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 23, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.