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General NPI Number Information
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NPI Number | 1942793260
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Entity Type | Organization
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Legal Business Name | CLEARPOINT PSYCHOLOGY, LLC
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Dates
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Enumeration Date | 06/11/2018
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Last Update Date | 06/11/2018
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Provider Practice Location Address
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Address Line | 2201 CENTRAL AVE STE 300
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City | ST PETERSBURG
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State | FL
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Zip | 33713-8844
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Country | US
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Telephone | 727-388-9003
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Fax |
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Provider Business Mailing Address
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Address Line | 2201 CENTRAL AVE STE 300
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City | ST PETERSBURG
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State | FL
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Zip | 33713-8844
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | DAWN SUKSANONG
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Credential | PSYD
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Telephone | 727-388-9003
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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 | PY9286
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License Number State | FL
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