Provider Demographics
NPI:1538365556
Name:FAMILY AND PEDIATRIC CLINIC
Entity type:Organization
Organization Name:FAMILY AND PEDIATRIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:LEHTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-784-5367
Mailing Address - Street 1:3000 N ATLANTIC AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:COCOA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32931-5045
Mailing Address - Country:US
Mailing Address - Phone:321-784-5367
Mailing Address - Fax:
Practice Address - Street 1:3000 N ATLANTIC AVE STE 102
Practice Address - Street 2:
Practice Address - City:COCOA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32931-5045
Practice Address - Country:US
Practice Address - Phone:321-784-5367
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health