Provider Demographics
NPI:1366532202
Name:FLORIAN, ZSOMBOR PETER (MA, LP)
Entity type:Individual
Prefix:MR
First Name:ZSOMBOR
Middle Name:PETER
Last Name:FLORIAN
Suffix:
Gender:M
Credentials:MA, LP
Other - Prefix:MR
Other - First Name:Z.
Other - Middle Name:PETER
Other - Last Name:FLORIAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LP
Mailing Address - Street 1:1000 LAKE SAINT LOUIS BLVD
Mailing Address - Street 2:STE 252
Mailing Address - City:LAKE ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63367-2924
Mailing Address - Country:US
Mailing Address - Phone:636-625-2409
Mailing Address - Fax:636-625-2409
Practice Address - Street 1:1000 LAKE SAINT LOUIS BLVD
Practice Address - Street 2:STE 252
Practice Address - City:LAKE SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63367-2924
Practice Address - Country:US
Practice Address - Phone:636-625-2409
Practice Address - Fax:636-625-2409
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOPYO1444103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO493680227Medicaid
MO493680227Medicaid
MOR00867Medicare UPIN