Provider Demographics
NPI:1366542920
Name:POETTER, VIOLET D (PSYD)
Entity type:Individual
Prefix:DR
First Name:VIOLET
Middle Name:D
Last Name:POETTER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3002 SE 1ST AVE
Mailing Address - Street 2:#200
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-0477
Mailing Address - Country:US
Mailing Address - Phone:352-351-5522
Mailing Address - Fax:352-351-2950
Practice Address - Street 1:3002 SE 1ST AVE
Practice Address - Street 2:#200
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-0477
Practice Address - Country:US
Practice Address - Phone:352-351-5522
Practice Address - Fax:352-351-2950
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0003308103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1174637268OtherNPI GROUP
75294OtherBCBS
1366542920OtherPERSONAL NPI
75294OtherBCBS
FLK0069Medicare ID - Type UnspecifiedGROUP