Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TB0200X | Cognitive & Behavioral Psychologist | 6237 | FL |
Y | 103G00000X | Clinical Psychologist | 6237 | FL |
Y | 103TC0700X | Clinical Psychologist | 6237 | FL |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 6237 | FL |
N | 103TH0100X | Health Service | 6237 | FL |
NPI | 1013989433 |
---|---|
Provider Name | Dr. Diane A. Mckay |
First Address | Tallevast, FL 34270-0903 |
Second Address | Sarasota, FL 34236-5955 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2006 |
Last Update Date | 07/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
54681 | BCBS PROVIDER # (01) | FL |
P18376 | (02) | FL |