Provider Demographics
NPI:1578751384
Name:CLINICAL & HEALTH PSYCHOLOGY
Entity Type:Organization
Organization Name:CLINICAL & HEALTH PSYCHOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:GERARD
Authorized Official - Last Name:STANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:904-448-0079
Mailing Address - Street 1:6545 BOWDEN RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-6149
Mailing Address - Country:US
Mailing Address - Phone:904-448-0079
Mailing Address - Fax:904-636-9661
Practice Address - Street 1:6545 BOWDEN RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-6149
Practice Address - Country:US
Practice Address - Phone:904-448-0079
Practice Address - Fax:904-636-9661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-05
Last Update Date:2021-05-18
Deactivation Date:2018-11-20
Deactivation Code:
Reactivation Date:2021-05-18
Provider Licenses
StateLicense IDTaxonomies
FLPY3949103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL73192Medicare PIN