Provider Demographics
NPI:1124117379
Name:MAVRIDES, LOUIS R (PHD)
Entity type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:R
Last Name:MAVRIDES
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:L.
Other - Middle Name:RUSSELL
Other - Last Name:MAVRIDES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:5275 PINEVIEW WAY
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-1962
Mailing Address - Country:US
Mailing Address - Phone:407-522-4652
Mailing Address - Fax:
Practice Address - Street 1:5275 PINEVIEW WAY
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-1962
Practice Address - Country:US
Practice Address - Phone:407-295-5800
Practice Address - Fax:407-295-5800
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0004756103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL61-57441OtherUNITED HEALTH CARE
CA1537714OtherUNITED MINE WORKERS OF AM
FL61-57441OtherUNITED HEALTH CARE
FL73968XMedicare ID - Type UnspecifiedUNDER GROUP #K0780