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General NPI Number Information
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NPI Number | 1619362654
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Entity Type | Organization
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Legal Business Name | BLUE SKY PSYCHOLOGICAL SERVICES, PA
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Dates
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Enumeration Date | 04/06/2015
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Last Update Date | 04/06/2015
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Provider Practice Location Address
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Address Line | 2459 IXORA AVE
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City | SARASOTA
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State | FL
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Zip | 34234-7328
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Country | US
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Telephone | 941-544-5235
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 750834
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City | FOREST HILLS
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State | NY
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Zip | 11375-0834
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Country | US
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Telephone | 718-268-6600
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Fax | 718-268-6065
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Authorized Official
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Title or Position | OWNER
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Name | DR. LYNN SKY MANNING
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Credential | PSYD
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Telephone | 718-268-6600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY6161
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License Number State | FL
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