Provider Demographics
NPI:1033558044
Name:ALLISON L NEVIN, PSY.D., PLLC
Entity Type:Organization
Organization Name:ALLISON L NEVIN, PSY.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:L
Authorized Official - Last Name:NEVIN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:321-676-8990
Mailing Address - Street 1:3682 N WICKHAM RD
Mailing Address - Street 2:SUITE B1 #270
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-2325
Mailing Address - Country:US
Mailing Address - Phone:321-676-8990
Mailing Address - Fax:321-499-4682
Practice Address - Street 1:2306 S BABCOCK ST
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-5308
Practice Address - Country:US
Practice Address - Phone:321-676-8990
Practice Address - Fax:321-499-4682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-24
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7179103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009822800Medicaid