MEDICARE: DR. JOHN MIHALOVICH PH.D.

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	103G00000X	Clinical Neuropsychologist	PY0002766	FL
2	103TC1900X	Counseling Psychologist	PY0002766	FL
3	103T00000X	Psychologist	PY0002766	FL

General Provider Information

NPI Number	:	1265473409
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN MIHALOVICH PH.D.

Provider Business Mailing Address
First Line	:	2850 SE CALVIN ST
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34952-5808
Country	:	US
Telephone Number	:	772-335-5505
Fax Number	:

Provider Business Practice Location Address
First Line	:	614 NE JENSEN BEACH BLVD
Second Line	:
City	:	JENSEN BEACH
State	:	FL
Zip	:	34957-4750
Country	:	US
Telephone Number	:	772-370-9836
Fax Number	:	772-225-1226

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

Provider Enumeration Date	:	06/09/2006
Last Update Date	:	09/11/2025

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