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General NPI Number Information
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NPI Number | 1639339609
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Entity Type | Organization
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Legal Business Name | LEVERMORE PSYCHOLOGICAL SERVICES, P.A.
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Dates
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Enumeration Date | 06/13/2008
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Last Update Date | 06/13/2008
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Provider Practice Location Address
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Address Line | 15715 S DIXIE HWY SUITE 334
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City | PALMETTO BAY
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State | FL
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Zip | 33157-1800
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Country | US
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Telephone | 305-763-9095
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Fax |
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Provider Business Mailing Address
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Address Line | 15715 S DIXIE HWY SUITE 334
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City | PALMETTO BAY
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State | FL
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Zip | 33157-1800
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Country | US
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Telephone | 305-763-9095
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/LICENSED CLINICAL PSYCHOL
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Name | DR. MONIQUE LEVERMORE
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Credential | PH.D.
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Telephone | 305-763-9095
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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 | PY 5628
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License Number State | FL
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