Organization
LAKE BEHAVIORAL HEALTH MANAGEMENT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID CORDDRY (OWNER)
(407) 622-8086
Entity
Organization
Contact information
Practice address
225 W CANTON AVE STE 600, WINTER PARK, FL 32789-3181
(407) 622-8086
Mailing address
225 W CANTON AVE STE 600, WINTER PARK, FL 32789-3181
(407) 622-8086
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
—
—
2084P0805X
Geriatric Psychiatry Physician
Primary
—
—
Other
Enumeration date
11/27/2018
Last updated
11/27/2018
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