Provider Demographics
NPI:1639339609
Name:LEVERMORE PSYCHOLOGICAL SERVICES, P.A.
Entity Type:Organization
Organization Name:LEVERMORE PSYCHOLOGICAL SERVICES, P.A.
Other - Org Name:MONIQUE LEVERMORE PH.D.
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT/LICENSED CLINICAL PSYCHOL
Authorized Official - Prefix:DR
Authorized Official - First Name:MONIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVERMORE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:305-763-9095
Mailing Address - Street 1:15715 S DIXIE HWY
Mailing Address - Street 2:SUITE 334
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-1800
Mailing Address - Country:US
Mailing Address - Phone:305-763-9095
Mailing Address - Fax:
Practice Address - Street 1:15715 S DIXIE HWY
Practice Address - Street 2:SUITE 334
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-1800
Practice Address - Country:US
Practice Address - Phone:305-763-9095
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-13
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 5628103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty