Organization
THE MEMORY DOCTOR, LLC
Active
Organization
THE MEMORY DOCTOR, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRENDA MASON (OFFICE MANAGER)
(352) 530-2170
Entity
Organization
Contact information
Practice address
26540 ACE AVE STE E-106, LEESBURG, FL 34748-8279
(352) 530-2170
(352) 530-2180
Mailing address
26540 ACE AVE STE E-106, LEESBURG, FL 34748-8279
(352) 530-2170
(352) 530-2180
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
PY6497
FL
103T00000X
Psychologist
PY6497
FL
Other
Enumeration date
06/01/2005
Last updated
03/29/2021
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