Healthcare Provider Details

I. General information

NPI: 1356441216
Provider Name (Legal Business Name): SUNRISE PSYCHOLOGICAL SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 10/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 N COLLIER BLVD FL 4
MARCO ISLAND FL
34145-2725
US

IV. Provider business mailing address

14398 MANCHESTER DR
NAPLES FL
34114-8626
US

V. Phone/Fax

Practice location:
  • Phone: 239-280-6061
  • Fax:
Mailing address:
  • Phone: 239-280-6061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License NumberPY3245
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License NumberPY3245
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPY3245
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY3245
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPY3245
License Number StateFL
# 6
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY3245
License Number StateFL

VIII. Authorized Official

Name: DR. CONSTANCE ARIA
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 239-280-6061