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LISA SUNDVALL MERILSON PSY.D.

Clinical Neuropsychologist

New Smyrna Beach, Florida

Provider NPI: 1932140175

Provider Information:
 LISA SUNDVALL MERILSON PSY.D.
Gender: F
Not Sole Proprietor

Practice Location:
221 N CAUSEWAY SUITE B NEW SMYRNA BEACH, FL 32169 US
Tel: 386-423-0442  Fax: 386-423-0402

Business Mailing Address:
221 N CAUSEWAY SUITE B NEW SMYRNA BEACH, FL 32169 US
Tel: 386-423-0442  Fax: 386-423-0402

Entity Type: Individual

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
X103G00000XBehavioral Health & Social Service Providers
Clinical Neuropsychologist
FLPY 6889
X103T00000XBehavioral Health & Social Service Providers
Psychologist
FLPY6889

Other Provider Identifiers:

IssuerNumberStateType
AETNA7280563FL01
BLUE CROSS BLUE SHIELD74094FL01
DISABILITY DETERMINATIONS1416FL01
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin







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