Provider Demographics
NPI:1972719193
Name:SUNSHINE PSYCHOLOGICAL CENTER LLC
Entity Type:Organization
Organization Name:SUNSHINE PSYCHOLOGICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:GLICERIA
Authorized Official - Middle Name:ZORAIDA
Authorized Official - Last Name:CALVO -SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-424-4946
Mailing Address - Street 1:5856 LOMA VISTA DRIVE WEST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33896
Mailing Address - Country:US
Mailing Address - Phone:863-424-4946
Mailing Address - Fax:863-424-4946
Practice Address - Street 1:5730 LOMA VISTA DRIVE WEST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33896
Practice Address - Country:US
Practice Address - Phone:863-424-4923
Practice Address - Fax:863-424-4946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT1842106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty