David Brockway, Psy.D
Psychologist in St Petersburg, FL. Individual provider (NPI-1).
NPI number1821494022
StatusActive
Last updated in NPPESMay 19, 2016
Details
- NPI
- 1821494022
- Entity type
- Individual (NPI-1)
- Name
- David Brockway
- Credential
- Psy.D
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Nov 15, 2014
- Last updated
- May 19, 2016
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 103T00000X | Psychologist | 0471010316 | FL | Yes |
| 102L00000X | Psychoanalyst | 102L00000X | VT |
Practice location
3730 18th Ave NSt Petersburg, FL 33713-4816
Phone 727-666-2429
Mailing address
3730 18th Ave NSt Petersburg, FL 33713-4816
Phone 727-666-2429
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