The Fedora Psychological Group, LLC

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PY 8491 Issued in FL

Legal business name

THE FEDORA PSYCHOLOGICAL GROUP, LLC

Practice address

1913 Tyrone Blvd N
St Petersburg, FL 33710-4841

Phone

(727) 282-5573

Fax

(813) 501-1173

NPI assigned

Dec 18, 2012

Last updated

May 13, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Roberto Alves, PSY.D.NPI 1235404724

Title

President

Phone

(727) 209-7792

Specialties & licenses 5

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Roberto Alves, PSYD

  • Clinical Psychologist
  • Pinellas Park, FL
  • NPI 1235404724
  Medicare reassignment NPD Authorized official
• Kristen Michaela Sturdevant, PSY.D.

  • Clinical Psychologist
  • St Petersburg, FL
  • NPI 1689879934
  Medicare reassignment NPD

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

{
    "created_epoch": "1355788800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1463097600000",
    "number": "1285970277",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 49284",
            "city": "SAINT PETERSBURG",
            "state": "FL",
            "postal_code": "337439284",
            "telephone_number": "727-209-7792",
            "fax_number": "813-501-1173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1913 TYRONE BLVD N",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337104841",
            "telephone_number": "727-282-5573",
            "fax_number": "813-501-1173"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE FEDORA PSYCHOLOGICAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-18",
        "last_updated": "2016-05-13",
        "status": "A",
        "authorized_official_last_name": "ALVES",
        "authorized_official_first_name": "ROBERTO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "727-209-7792",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "FL",
            "license": "PY 8491",
            "primary": true
        },
        {
            "code": "103TA0400X",
            "taxonomy_group": "",
            "desc": "Psychologist, Addiction (Substance Use Disorder)",
            "state": "FL",
            "license": "PY 8491",
            "primary": false
        },
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "FL",
            "license": "PY 8491",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "FL",
            "license": "PY 8491",
            "primary": false
        },
        {
            "code": "103TP2701X",
            "taxonomy_group": "",
            "desc": "Psychologist, Group Psychotherapy",
            "state": "FL",
            "license": "PY 8491",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychologist in St Petersburg, FL
• Providers in St Petersburg, FL by specialty
• Psychologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.