Individual
ILEANA BASCUAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
725 N 12TH AVE BLDG B, ARCADIA, FL 34266-8752
(863) 494-1242
(863) 491-0466
Mailing address
PO BOX 22197, SARASOTA, FL 34276-5197
(941) 809-4091
(941) 845-4963
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PY5016
FL
103TC0700X
Clinical Psychologist
PY5016
FL
Other
Enumeration date
09/26/2006
Last updated
05/14/2019
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