Healthcare Provider Details

I. General information

NPI: 1235957242
Provider Name (Legal Business Name): MADISON A BOBLETT-HUNT PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2024
Last Update Date: 09/30/2024
Certification Date: 09/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2415 UNIVERSITY PKWY STE 219
SARASOTA FL
34243-2809
US

IV. Provider business mailing address

224 CANTABRIA TRL
BRADENTON FL
34208-1584
US

V. Phone/Fax

Practice location:
  • Phone: 727-222-5703
  • Fax: 800-687-1938
Mailing address:
  • Phone: 614-678-0130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number12393
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: