Individual
DR. IDA MARIE EWEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
901 VENETIA BAY BLVD, SUITE 358, VENICE, FL 34285-8041
(941) 484-5431
(941) 727-8005
Mailing address
6410 SPYGLASS LN, BRADENTON, FL 34202-1707
(941) 484-5431
(941) 727-8005
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
00005326
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
59801
BLUE CROSS BLUE SHIELD ID
FL
Enumeration date
10/01/2006
Last updated
10/10/2009
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