Provider Demographics
NPI:1386652758
Name:SHINITZKY, HAROLD E (PSYD)
Entity Type:Individual
Prefix:
First Name:HAROLD
Middle Name:E
Last Name:SHINITZKY
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2750 N MCMULLEN BOOTH RD
Mailing Address - Street 2:SUITE 102-B
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-3362
Mailing Address - Country:US
Mailing Address - Phone:727-560-2697
Mailing Address - Fax:866-469-3880
Practice Address - Street 1:2750 N MCMULLEN BOOTH RD
Practice Address - Street 2:SUITE 102-B
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-3362
Practice Address - Country:US
Practice Address - Phone:727-560-2697
Practice Address - Fax:866-469-3880
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY4899103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001088OtherVALUE OPTIONS
FL185504OtherCOMPSYCH CORP
FL54695OtherBLUE SHIELD OF FLORIDA
FL185504OtherCOMPSYCH CORP