Individual
MARY CHARBONNEAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
2020 COMMERCE DR, WEST MELBOURNE, FL 32904
(321) 952-6000
Mailing address
2020 COMMERCE DR, WEST MELBOURNE, FL 32904
(321) 952-6000
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PY0007324
FL
Other
Enumeration date
10/02/2006
Last updated
07/08/2007
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