Provider Demographics
NPI:1063717908
Name:FORTNEY THERAPEUTICS PLC
Entity type:Organization
Organization Name:FORTNEY THERAPEUTICS PLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:FORTNEY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:239-443-0498
Mailing Address - Street 1:2760 GRAY FOX LN
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32826-3693
Mailing Address - Country:US
Mailing Address - Phone:239-443-0498
Mailing Address - Fax:
Practice Address - Street 1:100 RIALTO PL
Practice Address - Street 2:SUITE 754
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3055
Practice Address - Country:US
Practice Address - Phone:321-728-9620
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-25
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8142103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty