Provider Demographics
NPI:1356580955
Name:LYNDA GURVITZ PHD INC
Entity type:Organization
Organization Name:LYNDA GURVITZ PHD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LYNDA
Authorized Official - Middle Name:IRENE
Authorized Official - Last Name:GURVITZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:727-585-7164
Mailing Address - Street 1:801 W BAY DR
Mailing Address - Street 2:SUITE 607
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33770-3269
Mailing Address - Country:US
Mailing Address - Phone:727-585-7164
Mailing Address - Fax:
Practice Address - Street 1:801 W BAY DR
Practice Address - Street 2:SUITE 607
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-3269
Practice Address - Country:US
Practice Address - Phone:727-585-7164
Practice Address - Fax:727-585-0894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-05
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1186976OtherAMERIGROUP
FL75601OtherBLUE CROSS/BLUE SHIELD
FL75601Medicare PIN