Healthcare Provider Details

I. General information

NPI: 1962206292
Provider Name (Legal Business Name): ALESSANDRA M BEAUCHAMP LEBRON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2025
Last Update Date: 09/28/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 BRUCE B. DOWNS BLVD
TAMPA FL
33612
US

IV. Provider business mailing address

1105 CALLE ETHEL MARIN
MAYAGUEZ PR
00682-7756
US

V. Phone/Fax

Practice location:
  • Phone: 813-972-2000
  • Fax:
Mailing address:
  • Phone: 787-464-3308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number8647
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: