Provider Demographics
NPI:1407281413
Name:GULF COAST PSYCHOLOGY, INC
Entity Type:Organization
Organization Name:GULF COAST PSYCHOLOGY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PASQUALE
Authorized Official - Middle Name:A
Authorized Official - Last Name:CAPOZZOLI
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:239-274-7792
Mailing Address - Street 1:5237 SUMMERLIN COMMONS BLVD
Mailing Address - Street 2:SUITE 116
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-2158
Mailing Address - Country:US
Mailing Address - Phone:239-274-7792
Mailing Address - Fax:239-247-5344
Practice Address - Street 1:5237 SUMMERLIN COMMONS BLVD
Practice Address - Street 2:SUITE 116
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-2158
Practice Address - Country:US
Practice Address - Phone:239-274-7792
Practice Address - Fax:239-247-5344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-09
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8575103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty