Provider Demographics
NPI:1407067143
Name:LEVASSEUR, JAMES BRUCE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:BRUCE
Last Name:LEVASSEUR
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32726-4026
Mailing Address - Country:US
Mailing Address - Phone:813-598-3259
Mailing Address - Fax:407-374-5112
Practice Address - Street 1:12909 N 56TH ST
Practice Address - Street 2:SUITE 209
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33617-1275
Practice Address - Country:US
Practice Address - Phone:813-980-2094
Practice Address - Fax:813-980-2094
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 5991103G00000X, 103TB0200X, 103TC0700X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic