Provider Demographics
NPI:1235917758
Name:GENSMER, NICHOLAS (PHD, LP)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:
Last Name:GENSMER
Suffix:
Gender:M
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8329 BELLA GROVE CIR UNIT 302
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34243-2119
Mailing Address - Country:US
Mailing Address - Phone:941-323-1654
Mailing Address - Fax:
Practice Address - Street 1:8329 BELLA GROVE CIR UNIT 302
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34243-2119
Practice Address - Country:US
Practice Address - Phone:941-323-1654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY11976103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical