OrganizationActive
Child & Adolescent Treatment Center
NPI 1306039243 · Clinical Child & Adolescent Psychologist · Winter Park, FL
Provider details
- NPI number
- 1306039243
- Entity type
- Organization
- Primary specialty
- Clinical Child & Adolescent PsychologistBehavioral Health & Social Service Providers
- Authorized official
- Robert C Coolidge, Agent/Representative
- License
- PY6399 (FL)
Practice location
1950 Lee Rd
Suite 202
Winter Park, FL 32789-1859
Phone: (407) 739-5874
Fax: (407) 644-1292
Mailing address
Po Box 741240
Orange City, FL 32774-1240
Registry dates
- Enumerated
- 2007-08-23
- Last updated
- 2008-04-20
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.