Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PY4126 | FL |
Y | 103TC0700X | Clinical Psychologist | PY4126 | FL |
NPI | 1003821935 |
---|---|
Provider Name | Earl Frank Rectanus JR. |
First Address | Naples, FL 34103-4456 |
Second Address | Naples, FL 34103-4456 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
73485 | (02) | FL |