Healthcare Provider Details

I. General information

NPI: 1831443118
Provider Name (Legal Business Name): TONI ANN SERPE PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2012
Last Update Date: 06/08/2023
Certification Date: 06/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

871 VENETIA BAY BLVD STE 310
VENICE FL
34285-8054
US

IV. Provider business mailing address

13169 STEINHATCHEE LOOP
VENICE FL
34293-1247
US

V. Phone/Fax

Practice location:
  • Phone: 941-346-6465
  • Fax:
Mailing address:
  • Phone: 631-921-8393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY11022
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number602566
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number019682-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: