Individual
JOHN WALTER PATRICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
4643 S CLYDE MORRIS BLVD, SUITE 306, PORT ORANGE, FL 32129-6000
(386) 761-3101
Mailing address
5911 RIVERSIDE DR, PORT ORANGE, FL 32127-6445
(386) 761-3101
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PY3313
FL
Other
Enumeration date
06/27/2006
Last updated
07/08/2007
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