Mid State Mental Health Assessment Inc

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PY8461 Issued in FL

Legal business name

MID STATE MENTAL HEALTH ASSESSMENT INC

Practice address

7052 Annunciation Circle
Suite 329
Ave Maria, FL 34142-0000

Phone

(239) 352-4004

NPI assigned

Oct 13, 2009

Organization subpart

No

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

Authorized official

Name

Dr. Bruce Edward Malcolm, PSY.D.

Title

President

Phone

(239) 352-4004

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1255392000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1360108800000",
    "number": "1215262977",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5819 PLYMOUTH PL",
            "city": "AVE MARIA",
            "state": "FL",
            "postal_code": "341429586",
            "telephone_number": "239-352-4004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7052 ANNUNCIATION CIRCLE",
            "address_2": "SUITE 329",
            "city": "AVE MARIA",
            "state": "FL",
            "postal_code": "341420000",
            "telephone_number": "239-352-4004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID STATE MENTAL HEALTH ASSESSMENT INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-13",
        "last_updated": "2013-02-06",
        "status": "A",
        "authorized_official_last_name": "MALCOLM",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "239-352-4004",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": "FL",
            "license": "PY8461",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychologist in Ave Maria, FL
• Providers in Ave Maria, FL by specialty
• Psychologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2013; 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.