William H Pettibon PHD PA

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PY6096 Issued in FL

Legal business name

WILLIAM H PETTIBON PHD PA

Practice address

3800 S Tamiami TRL Unit 210
Sarasota, FL 34239-6909

Phone

(941) 366-1693

Fax

(941) 922-7574

NPI assigned

Apr 28, 2008

Organization subpart

No

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

Authorized official

Name

Dr. William Harry Pettibon, PH.DNPI 1629267877

Title

Clinical Psychologist/Owner

Phone

(941) 366-1693

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Tax ID family

William H Pettibon PHD2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• William H Pettibon PHD

  • Specialist
  • Sarasota, FL
  • NPI 1104839042
  NPD tax ID

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• William Harry Pettibon, PHD

  • Psychologist
  • Sarasota, FL
  • NPI 1629267877
  Medicare reassignment Care Compare group NPD Authorized official
• Paula Cooper, PHD

  • Psychologist
  • Sarasota, FL
  • NPI 1043294325
  Medicare reassignment Care Compare group NPD
• William Nicholas Vanderstine, LCSW

  • Clinical Social Worker
  • Sarasota, FL
  • NPI 1437454212
  Medicare reassignment Care Compare group NPD
• Rachel Joy Wiseman, PH.D.

  • Clinical Neuropsychologist
  • Sarasota, FL
  • NPI 1447425137
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1209340800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1209340800000",
    "number": "1336314707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6521 KEYSTONE DR",
            "city": "SARASOTA",
            "state": "FL",
            "postal_code": "342317133",
            "telephone_number": "941-922-7574",
            "fax_number": "941-922-7574"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3800 S TAMIAMI TRL UNIT 210",
            "city": "SARASOTA",
            "state": "FL",
            "postal_code": "342396909",
            "telephone_number": "941-366-1693",
            "fax_number": "941-922-7574"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLIAM H PETTIBON PHD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-28",
        "last_updated": "2008-04-28",
        "status": "A",
        "authorized_official_last_name": "PETTIBON",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "HARRY",
        "authorized_official_title_or_position": "CLINICAL PSYCHOLOGIST/OWNER",
        "authorized_official_telephone_number": "941-366-1693",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": "FL",
            "license": "PY6096",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• William Michael Wilkins, PHARMD
• Leigh Suzanne Willey, APRN
• William Elstein MD PA
• William F Bennett MD PA
• William H Pettibon PHD
• Joanne Williams Mainberger, LMHC
• Alexandra Dulout Williams, M.D.
• Carl Frederick Williams, RCIS
• Cliffany N Williams, PHARM D
• David Williams

• Psychologist in Sarasota, FL
• Providers in Sarasota, FL by specialty
• Psychologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2008; 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.