Provider Demographics
NPI:1811982598
Name:MCGOVERN, JAMES M (PSYD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:M
Last Name:MCGOVERN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1023 MANATEE AVE W STE 302
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34205-7816
Mailing Address - Country:US
Mailing Address - Phone:941-405-3614
Mailing Address - Fax:941-216-3323
Practice Address - Street 1:1023 MANATEE AVE W STE 302
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-7816
Practice Address - Country:US
Practice Address - Phone:941-405-6413
Practice Address - Fax:941-216-3323
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY4238103T00000X, 103TB0200X, 103TC0700X, 103TC2200X, 103TF0200X, 103TH0100X, 103TM1800X, 103TR0400X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL680010165OtherRAIL ROAD MEDICARE
FL73532OtherBCBS
FL73532WMedicare PIN
FLR99719Medicare UPIN