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Organization

MELBOURNE MEDPSYCH PLLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
GERALD R SHOWALTER PSY.D. (MBR)
(540) 447-0134
Entity
Organization

Contact information

Practice address
1915 OAK STREET, MELBOURNE, FL 32901
(540) 447-0134
(540) 932-7611
Mailing address
406 AVENUE B, MELBOURNE BEACH, FL 32951-2215
(540) 447-0134

Taxonomy

Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
103TC0700X
Clinical Psychologist

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
PY10639
FLORIDA BOARD OF PSYCHOLOGY
FL
Enumeration date
08/01/2022
Last updated
09/13/2022
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