| William H Pettibon Phd Pa | |
|
3800 S Tamiami Trl Unit 210 Sarasota FL 34239-6909 | |
| (941) 366-1693 | |
| (941) 922-7574 |
| Full Name | William H Pettibon Phd Pa |
|---|---|
| Speciality | Psychologist |
| Location | 3800 S Tamiami Trl Unit 210, Sarasota, Florida |
| Authorized Official Name and Position | William Harry Pettibon (CLINICAL PSYCHOLOGIST/OWNER) |
| Authorized Official Contact | 9413661693 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| William H Pettibon Phd Pa 6521 Keystone Dr Sarasota FL 34231-7133 Ph: (941) 922-7574 | William H Pettibon Phd Pa 3800 S Tamiami Trl Unit 210 Sarasota FL 34239-6909 Ph: (941) 366-1693 |
| NPI Number | 1336314707 |
|---|---|
| Provider Enumeration Date | 04/28/2008 |
| Last Update Date | 04/28/2008 |
| Medicare PECOS PAC ID | 7618025131 |
|---|---|
| Medicare Enrollment ID | O20090511000172 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336314707 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | PY6096 (Florida) | Primary |
| Provider Name | Paula L Cooper |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1043294325 PECOS PAC ID: 8224053228 Enrollment ID: I20051010000226 |
| Provider Name | Rachel J Wiseman |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1447425137 PECOS PAC ID: 0941376362 Enrollment ID: I20080909000700 |
| Provider Name | William Pettibon |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1629267877 PECOS PAC ID: 7416005939 Enrollment ID: I20100420000926 |
| Provider Name | William N Vanderstine |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1437454212 PECOS PAC ID: 6800070319 Enrollment ID: I20110407000449 |
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