Provider Demographics
NPI:1437431509
Name:MISSORY, MICHAEL PATRICK (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:PATRICK
Last Name:MISSORY
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11300 4TH ST N
Mailing Address - Street 2:SUITE 115
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33716-2918
Mailing Address - Country:US
Mailing Address - Phone:727-619-4477
Mailing Address - Fax:727-258-2348
Practice Address - Street 1:11300 4TH ST N
Practice Address - Street 2:SUITE 115
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33716-2918
Practice Address - Country:US
Practice Address - Phone:727-619-4477
Practice Address - Fax:727-258-2348
Is Sole Proprietor?:No
Enumeration Date:2011-09-15
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 8375103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFK170ZMedicare Oscar/Certification