Individual
MARGARET R MORTENSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
2401 W EAU GALLIE BLVD, SUITE 1, MELBOURNE, FL 32935-2765
(321) 327-5952
(321) 327-5954
Mailing address
2401 W EAU GALLIE BLVD, SUITE 1, MELBOURNE, FL 32935-2765
(321) 327-5952
(321) 327-5954
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PY4165
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
090953
VALUE OPTIONS
—
Enumeration date
08/09/2006
Last updated
11/10/2016
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