Individual provider Active NPI

James Bruce Levasseur, PH.D.

  • Clinical Neuropsychologist
  • Temple Terrace, FL
National Provider Identifier
1407067143
Registry record updated Oct 24, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical NeuropsychologistTaxonomy code 103G00000X
License
PY 5991 Issued in FL
Practice address
12909 N 56TH St
Suite 209
Temple Terrace, FL 33617-1275
Phone
(813) 980-2094
Fax
(813) 980-2094
NPI assigned
May 24, 2007
Last updated
Oct 24, 2018By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 24, 2018

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Neuropsychologist 103G00000X PY 5991 FL Primary
Cognitive & Behavioral Psychologist 103TB0200X PY 5991 FL
Clinical Psychologist 103TC0700X PY 5991 FL
Forensic Psychologist 103TF0200X PY 5991 FL

Addresses

Primary practice location

12909 N 56TH St
Suite 209
Temple Terrace, FL 33617-1275

Mailing address

507 Lakeshore Dr
Eustis, FL 32726-4026
Phone (813) 598-3259

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)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
PY 5991FLMDCognitive & Behavioral Psychologist

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1179964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1540339200000",
    "number": "1407067143",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "507 LAKESHORE DR",
            "city": "EUSTIS",
            "state": "FL",
            "postal_code": "327264026",
            "telephone_number": "813-598-3259",
            "fax_number": "407-374-5112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12909 N 56TH ST",
            "address_2": "SUITE 209",
            "city": "TEMPLE TERRACE",
            "state": "FL",
            "postal_code": "336171275",
            "telephone_number": "813-980-2094",
            "fax_number": "813-980-2094"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEVASSEUR",
        "first_name": "JAMES",
        "middle_name": "BRUCE",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-24",
        "last_updated": "2018-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "FL",
            "license": "PY 5991",
            "primary": true
        },
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "FL",
            "license": "PY 5991",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "FL",
            "license": "PY 5991",
            "primary": false
        },
        {
            "code": "103TF0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Forensic",
            "state": "FL",
            "license": "PY 5991",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Temple Terrace, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2018; 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.