Provider Demographics
NPI:1043297880
Name:TREMONT, GEOFFREY (PHD)
Entity Type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:
Last Name:TREMONT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:871 VENETIA BAY BLVD STE 310
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-8054
Mailing Address - Country:US
Mailing Address - Phone:941-346-6465
Mailing Address - Fax:716-242-3360
Practice Address - Street 1:871 VENETIA BAY BLVD STE 310
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-8054
Practice Address - Country:US
Practice Address - Phone:941-346-6465
Practice Address - Fax:716-242-3360
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS00634103TC0700X, 103G00000X
FLPY11928103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
007007280Medicare ID - Type Unspecified
S49741Medicare UPIN