Individual
DR. VIVIAN ANA LORETDEMOLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D
Contact information
Practice address
3599 W. LAKE MARY BLVD, SUITE B2, LAKE MARY, FL 32746
(386) 675-7467
(386) 256-3665
Mailing address
1502 N. PENINSULA DRIVE, DAYTONA BEACH, FL 32118
(386) 675-7467
(386) 256-3665
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PY5437
FL
103TC0700X
Clinical Psychologist
PY5437
FL
Other
Enumeration date
12/15/2017
Last updated
12/15/2017
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