Provider Demographics
NPI:1366159626
Name:SUNCOAST PSYCHOTHERAPY LLC
Entity type:Organization
Organization Name:SUNCOAST PSYCHOTHERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHAPIRO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, MPA
Authorized Official - Phone:941-900-8661
Mailing Address - Street 1:7673 RIDGELAKE CIR
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34203-2508
Mailing Address - Country:US
Mailing Address - Phone:941-900-8661
Mailing Address - Fax:
Practice Address - Street 1:7673 RIDGELAKE CIR
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34203-2508
Practice Address - Country:US
Practice Address - Phone:941-900-8661
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-04
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty