Provider Demographics
NPI:1487702502
Name:LEROM, DANIEL RONALD (PSYD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:RONALD
Last Name:LEROM
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5201 W KENNEDY BLVD
Mailing Address - Street 2:SUITE 620
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-1845
Mailing Address - Country:US
Mailing Address - Phone:813-281-9383
Mailing Address - Fax:813-349-1766
Practice Address - Street 1:5201 W KENNEDY BLVD
Practice Address - Street 2:SUITE 620
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-1845
Practice Address - Country:US
Practice Address - Phone:813-281-9383
Practice Address - Fax:813-349-1766
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0004407103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL73686Medicare ID - Type UnspecifiedPSYCHOLOGIST