| Shoreline Psychological Services, Llc | |
|
146 2nd St N Suite 310 St Petersburg FL 33701-3328 | |
| (727) 251-6874 | |
| Not Available |
| Full Name | Shoreline Psychological Services, Llc |
|---|---|
| Speciality | Psychologist |
| Location | 146 2nd St N, St Petersburg, Florida |
| Authorized Official Name and Position | Theodora Coffman (PSYCHOLOGIST) |
| Authorized Official Contact | 7273081180 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Shoreline Psychological Services, Llc 146 2nd St N Suite 310 St Petersburg FL 33701-3328 Ph: (727) 251-6874 | Shoreline Psychological Services, Llc 146 2nd St N Suite 310 St Petersburg FL 33701-3328 Ph: (727) 251-6874 |
| NPI Number | 1093257982 |
|---|---|
| Provider Enumeration Date | 11/09/2016 |
| Last Update Date | 06/16/2023 |
| Certification Date | 06/16/2023 |
| Medicare PECOS PAC ID | 7214397108 |
|---|---|
| Medicare Enrollment ID | O20230725000341 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093257982 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | PY9365 (Florida) | Primary |
| Provider Name | Theodora Coffman |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1922475599 PECOS PAC ID: 1850751744 Enrollment ID: I20230725000671 |
| Provider Name | Matthew Miceli |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1124780333 PECOS PAC ID: 2668833567 Enrollment ID: I20230725001427 |
| Provider Name | Michael Coffman |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1598414542 PECOS PAC ID: 3375901762 Enrollment ID: I20230918001916 |
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