Individual
DR. ATHENA BOOLUKOS GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
EDM, PSYD
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PY8510
FL
103TA0700X
Adult Development & Aging Psychologist
PY8510
FL
Other
Enumeration date
05/25/2012
Last updated
05/25/2012
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