Organization
MELBOURNE MEDPSYCH PLLC
Active
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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