Healthcare Provider Details

I. General information

NPI: 1811982598
Provider Name (Legal Business Name): JAMES M MCGOVERN PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1023 MANATEE AVE W STE 302
BRADENTON FL
34205-7816
US

IV. Provider business mailing address

1023 MANATEE AVE W STE 302
BRADENTON FL
34205-7816
US

V. Phone/Fax

Practice location:
  • Phone: 941-405-6413
  • Fax: 941-216-3323
Mailing address:
  • Phone: 941-405-3614
  • Fax: 941-216-3323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY4238
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPY4238
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY4238
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPY4238
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberPY4238
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License NumberPY4238
License Number StateFL
# 7
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License NumberPY4238
License Number StateFL
# 8
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License NumberPY4238
License Number StateFL
# 9
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPY4238
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: