Healthcare Provider Details

I. General information

NPI: 1972696839
Provider Name (Legal Business Name): PASHIA D GROOM PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 06/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

890 SOUTH PALAFOX STREET SUITE 300
PENSACOLA FL
32502
US

IV. Provider business mailing address

890 SOUTH PALAFOX STREET SUITE 300
PENSACOLA FL
32502
US

V. Phone/Fax

Practice location:
  • Phone: 850-433-1656
  • Fax: 850-433-1996
Mailing address:
  • Phone: 850-433-1656
  • Fax: 850-433-1996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY6255
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1163
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: