MEDICARE: GEOFFREY TREMONT PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PS00634	RI
2	103TC0700X	Clinical Psychologist	PY11928	FL
3	103G00000X	Clinical Neuropsychologist	PS00634	RI

General Provider Information

NPI Number	:	1043297880
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEOFFREY TREMONT PHD

Provider Business Mailing Address
First Line	:	871 VENETIA BAY BLVD STE 310
Second Line	:
City	:	VENICE
State	:	FL
Zip	:	34285-8054
Country	:	US
Telephone Number	:	941-346-6465
Fax Number	:	716-242-3360

Provider Business Practice Location Address
First Line	:	871 VENETIA BAY BLVD STE 310
Second Line	:
City	:	VENICE
State	:	FL
Zip	:	34285-8054
Country	:	US
Telephone Number	:	941-346-6465
Fax Number	:	716-242-3360

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/22/2005
Last Update Date	:	01/22/2024

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Directions to “ GEOFFREY TREMONT PHD” Practice Location

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