Provider Demographics
NPI:1710528237
Name:DYNAMIC PSYCHOMETRICS LLC
Entity Type:Organization
Organization Name:DYNAMIC PSYCHOMETRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:EMIL
Authorized Official - Last Name:JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D
Authorized Official - Phone:813-503-3652
Mailing Address - Street 1:13361 N 56TH ST OFC B
Mailing Address - Street 2:
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33617-1161
Mailing Address - Country:US
Mailing Address - Phone:727-279-5878
Mailing Address - Fax:833-720-9866
Practice Address - Street 1:13361 N 56TH ST OFC B
Practice Address - Street 2:
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33617-1161
Practice Address - Country:US
Practice Address - Phone:727-279-5878
Practice Address - Fax:833-720-9866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-06
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPY9007OtherPSYCHOLOGY LICENSE