Organization
MID STATE MENTAL HEALTH ASSESSMENT INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRUCE EDWARD MALCOLM PSY.D. (PRESIDENT)
(239) 352-4004
Entity
Organization
Contact information
Practice address
7052 ANNUNCIATION CIRCLE, SUITE 329, AVE MARIA, FL 34142-0000
(239) 352-4004
Mailing address
5819 PLYMOUTH PL, AVE MARIA, FL 34142-9586
(239) 352-4004
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PY8461
FL
Other
Enumeration date
10/13/2009
Last updated
02/06/2013
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