Individual
DR. LOUISE URBANC PETERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
6103 N ATLANTIC AVE, STE C, CAPE CANAVERAL, FL 32920-3976
(321) 514-2878
(954) 944-0308
Mailing address
3730 BIG PINE RD, MELBOURNE, FL 32934-8536
(321) 259-2745
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PY7171
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
558343
VALUE OPTIONS PROVIDER #
FL
01
—
5C57A98C68
TRICARE
FL
01
—
75323
BCBS PROVIDER NUMBER
FL
Enumeration date
05/22/2006
Last updated
12/10/2021
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