Individual
DR. CORI J. REVAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
13430 PARKER COMMONS BLVD STE 101, FORT MYERS, FL 33912-1812
(239) 561-9955
(239) 561-9779
Mailing address
13430 PARKER COMMONS BLVD STE 101, FORT MYERS, FL 33912-1812
(239) 561-9955
(239) 561-9779
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PY6814
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
74376
BCBS INDIVID. PROVIDER #
FL
01
—
74976
BCBS GROUP PROVIDER #
FL
Enumeration date
09/29/2006
Last updated
05/12/2026
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