Provider Demographics
NPI:1619362654
Name:BLUE SKY PSYCHOLOGICAL SERVICES, PA
Entity Type:Organization
Organization Name:BLUE SKY PSYCHOLOGICAL SERVICES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:SKY
Authorized Official - Last Name:MANNING
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:718-268-6600
Mailing Address - Street 1:PO BOX 750834
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-0834
Mailing Address - Country:US
Mailing Address - Phone:718-268-6600
Mailing Address - Fax:718-268-6065
Practice Address - Street 1:2459 IXORA AVE
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34234-7328
Practice Address - Country:US
Practice Address - Phone:941-544-5235
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-06
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6161103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPY6161OtherPROFESSIONAL LICENSE