Provider Demographics
NPI:1326268657
Name:CLINICAL HEALTH PSYCHOLOGY ASSOCIATES, LLC
Entity Type:Organization
Organization Name:CLINICAL HEALTH PSYCHOLOGY ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIE-ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:SALVIO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:352-341-0200
Mailing Address - Street 1:957 S. LOIS TERRACE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34452
Mailing Address - Country:US
Mailing Address - Phone:352-341-0200
Mailing Address - Fax:352-341-0700
Practice Address - Street 1:957 S. LOIS TERRACE
Practice Address - Street 2:SUITE 102
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34452
Practice Address - Country:US
Practice Address - Phone:352-341-0200
Practice Address - Fax:352-341-0700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-27
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT 1994103G00000X, 103TC0700X
FLPY 6989103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTCO2784Medicare ID - Type Unspecified
FLAC328Medicare PIN