# PAULA DEFOREST PHD LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Paula DeForest PhD
- **Organization subpart:** No

## Provider details

- **NPI number:** 1851776348
- **Authorized official:** DR. PAULA DEFOREST (PSYCHOLOGIST)
- **Authorized official phone:** (321) 305-5068

## Contact information

- **Practice address:** 1425 AURORA RD, MELBOURNE, FL 32935-5315
- **Practice address phone:** (321) 242-3110
- **Mailing address:** 2290 ROCKLEDGE DR, ROCKLEDGE, FL 32955-5404
- **Mailing address phone:** (321) 305-5068

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103T00000X | Psychologist | PY0004766 | FL | — |
| 103TB0200X | Cognitive & Behavioral Psychologist | PY0004766 | FL | — |
| 103TC0700X | Clinical Psychologist | PY0004766 | FL | — |
| 103TC1900X | Counseling Psychologist | PY0004766 | FL | — |
| 103TC2200X | Clinical Child & Adolescent Psychologist | PY0004766 | FL | Yes |
| 103TF0000X | Family Psychologist | PY0004766 | FL | — |
| 103TM1800X | Intellectual & Developmental Disabilities Psychologist | PY0004766 | FL | — |
| 103TS0200X | School Psychologist | PY0004766 | FL | — |

## Other

- **Enumeration date:** 07/24/2015
- **Last updated:** 07/24/2015