Healthcare Provider Details

I. General information

NPI: 1982316303
Provider Name (Legal Business Name): GRACE PSYCHOLOGICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2022
Last Update Date: 02/27/2026
Certification Date: 02/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10707 66TH ST N STE 9
PINELLAS PARK FL
33782-2336
US

IV. Provider business mailing address

10707 66TH ST N STE 9
PINELLAS PARK FL
33782-2336
US

V. Phone/Fax

Practice location:
  • Phone: 727-314-5001
  • Fax:
Mailing address:
  • Phone: 727-314-5001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERTO ALVES
Title or Position: OWNER
Credential: PSYD
Phone: 727-314-5001