Individual provider Active NPI

Lauren Patrusky, ED.S.

  • School Psychologist
  • Riverview, FL
National Provider Identifier
1174296685
Registry record updated Jul 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
School PsychologistTaxonomy code 103TS0200X
License
SS1513 Issued in FL
Practice address
10863 Boyette Rd
Riverview, FL 33569-8012
Phone
(941) 993-5639
NPI assigned
Jul 29, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
School Psychologist 103TS0200X SS1513 FL Primary

Addresses

Primary practice location

10863 Boyette Rd
Riverview, FL 33569-8012

Mailing address

4003 S West Shore Blvd Apt 2503
Tampa, FL 33611-1033
Phone (941) 993-5639

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
SS1513FLMDSchool Psychologist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1627516800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627516800000",
    "number": "1174296685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4003 S WEST SHORE BLVD APT 2503",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336111033",
            "telephone_number": "941-993-5639"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10863 BOYETTE RD",
            "city": "RIVERVIEW",
            "state": "FL",
            "postal_code": "335698012",
            "telephone_number": "941-993-5639"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PATRUSKY",
        "first_name": "LAUREN",
        "name_prefix": "Ms.",
        "credential": "ED.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-29",
        "last_updated": "2021-07-29",
        "certification_date": "2021-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TS0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, School",
            "state": "FL",
            "license": "SS1513",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverview, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.