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General NPI Number Information
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NPI Number | 1407067143
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Entity Type | Individual
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Provider Name | JAMES BRUCE LEVASSEUR PH.D.
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Gender | Male
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 10/24/2018
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Provider Practice Location Address
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Address Line | 12909 N 56TH ST SUITE 209
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City | TEMPLE TERRACE
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State | FL
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Zip | 33617-1275
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Country | US
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Telephone | 813-980-2094
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Fax | 813-980-2094
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Provider Business Mailing Address
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Address Line | 507 LAKESHORE DR
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City | EUSTIS
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State | FL
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Zip | 32726-4026
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Country | US
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Telephone | 813-598-3259
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Fax | 407-374-5112
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | PY 5991
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number | PY 5991
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY 5991
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 103TF0200X
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Taxonomy Name | Forensic Psychologist
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License Number | PY 5991
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License Number State | FL
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