Organization
THOMAS F. GUIDERA, PH.D, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS F GUIDERA PH.D., PA (OWNER-PRACTITIONER)
(321) 268-5682
Entity
Organization
Contact information
Practice address
1777 GARDEN STREET, TITUSVILLE, FL 32796-3221
(321) 268-5682
(321) 268-5683
Mailing address
1777 GARDEN STREET, TITUSVILLE, FL 32796-3221
(321) 268-5682
(321) 268-5683
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
PY 3165
FL
103TC0700X
Clinical Psychologist
Primary
PY0003165
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1770647810
CURRENT NPI
—
01
—
75434
MEDICARE PTAN
—
Enumeration date
06/13/2011
Last updated
05/15/2012
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