Organization
NEUROGENESIS CENTER OF FLORIDA, PLLC
Active
Other names
Amber Fasula, Psy.D.
Organization subpart
No
Provider details
NPI number
Authorized official
AMBER L FASULA (OWNER)
(407) 790-4101
Entity
Organization
Contact information
Practice address
253 N ORLANDO AVE STE 202, MAITLAND, FL 32751-5521
(407) 790-4101
(407) 277-4400
Mailing address
253 N ORLANDO AVE STE 202, MAITLAND, FL 32751-5521
(407) 790-4101
(407) 277-4400
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PY9333
FL
Other
Enumeration date
08/13/2015
Last updated
04/24/2021
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