Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PY6759 | FL |
Y | 103TC0700X | Clinical Psychologist | PY6759 | FL |
NPI | 1013116136 |
---|---|
Provider Name | Joan A Vail |
First Address | Venice, FL 34285-5572 |
Second Address | Venice, FL 34285-5572 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2007 |
Last Update Date | 18/07/2007 |