Provider Demographics
NPI:1386699213
Name:PETERS, LOUISE URBANC (PSYD)
Entity type:Individual
Prefix:DR
First Name:LOUISE
Middle Name:URBANC
Last Name:PETERS
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 1:3730 BIG PINE RD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32934-8536
Mailing Address - Country:US
Mailing Address - Phone:321-259-2745
Mailing Address - Fax:
Practice Address - Street 1:6103 N ATLANTIC AVE
Practice Address - Street 2:STE C
Practice Address - City:CAPE CANAVERAL
Practice Address - State:FL
Practice Address - Zip Code:32920-3976
Practice Address - Country:US
Practice Address - Phone:321-514-2878
Practice Address - Fax:954-944-0308
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-22
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7171103TC0700X
FLPY 7171103TF0000X, 103TH0100X, 103T00000X, 103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
Not Answered103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5C57A98C68OtherTRICARE
FL75323OtherBCBS PROVIDER NUMBER
FL558343OtherVALUE OPTIONS PROVIDER #
FLU6131Medicare PIN