| Grace Psychological Services, Llc | |
|
1913 Tyrone Blvd N St Petersburg FL 33710-4841 | |
| (727) 314-2560 | |
| Not Available |
| Full Name | Grace Psychological Services, Llc |
|---|---|
| Speciality | Psychologist |
| Location | 1913 Tyrone Blvd N, St Petersburg, Florida |
| Authorized Official Name and Position | Roberto Alves (MANAGER) |
| Authorized Official Contact | 7273145001 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Grace Psychological Services, Llc 1913 Tyrone Blvd N St Petersburg FL 33710-4841 Ph: (727) 314-2560 | Grace Psychological Services, Llc 1913 Tyrone Blvd N St Petersburg FL 33710-4841 Ph: (727) 314-2560 |
| NPI Number | 1982316303 |
|---|---|
| Provider Enumeration Date | 12/16/2022 |
| Last Update Date | 01/29/2023 |
| Certification Date | 01/29/2023 |
| Medicare PECOS PAC ID | 8123488582 |
|---|---|
| Medicare Enrollment ID | O20230717002022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982316303 | NPI | - | NPPES |
| 593Q2 | Other | FLORIDA BLUE | |
| 3963857 | Other | CIGNA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Roberto Alves |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1235404724 PECOS PAC ID: 6709175581 Enrollment ID: I20160518000547 |
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