Provider Demographics
NPI:1093957318
Name:MITCHELL KROUN GOLD, PH.D., P.A.
Entity Type:Organization
Organization Name:MITCHELL KROUN GOLD, PH.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:
Authorized Official - Last Name:KROUNGOLD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:727-442-6007
Mailing Address - Street 1:401 CORBETT ST STE 300
Mailing Address - Street 2:
Mailing Address - City:BELLEAIR
Mailing Address - State:FL
Mailing Address - Zip Code:33756-7303
Mailing Address - Country:US
Mailing Address - Phone:727-442-6007
Mailing Address - Fax:727-441-3981
Practice Address - Street 1:401 CORBETT ST STE 300
Practice Address - Street 2:
Practice Address - City:BELLEAIR
Practice Address - State:FL
Practice Address - Zip Code:33756-7303
Practice Address - Country:US
Practice Address - Phone:727-442-6007
Practice Address - Fax:727-441-3981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-01
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X, 103TA0400X, 103TB0200X, 103TC0700X, 103TC2200X, 103TF0000X, 103TF0200X
FLPY0002366103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Single Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Single Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamilyGroup - Single Specialty
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL75197Medicare PIN