Provider Demographics
NPI:1093189649
Name:CROOMS, COLLEEN MOCCO (PHD)
Entity Type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:MOCCO
Last Name:CROOMS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 N MCMULLEN BOOTH RD STE C1
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33759-2129
Mailing Address - Country:US
Mailing Address - Phone:727-228-2388
Mailing Address - Fax:850-727-7815
Practice Address - Street 1:1700 N MCMULLEN BOOTH RD STE C1
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33759-2129
Practice Address - Country:US
Practice Address - Phone:727-228-2388
Practice Address - Fax:727-228-2388
Is Sole Proprietor?:No
Enumeration Date:2015-11-19
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY003958103T00000X
FLPY9289103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist