Healthcare Provider Details

I. General information

NPI: 1780408203
Provider Name (Legal Business Name): BUTTERFIELD NEUROPSYCHOLOGY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2024
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 ULMERTON RD STE 625-308
CLEARWATER FL
33762-2300
US

IV. Provider business mailing address

1901 ULMERTON RD STE 625-308
CLEARWATER FL
33762-2300
US

V. Phone/Fax

Practice location:
  • Phone: 727-300-1920
  • Fax:
Mailing address:
  • Phone: 727-300-1920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. LONDON BUTTERFIELD
Title or Position: AP
Credential: PHD
Phone: 727-300-1920