NPIMap

Organization Active NPI

Pensacola Psychological Clinic PA

  • Clinical Psychologist
  • Pensacola, FL
National Provider Identifier
1730241209
Registry record updated Oct 22, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Legal business name
PENSACOLA PSYCHOLOGICAL CLINIC PA
Practice address
3 W Garden St
Ste 370
Pensacola, FL 32502-5641
Phone
(850) 433-1656
Fax
(850) 433-1996
NPI assigned
Dec 14, 2006
Last updated
Oct 22, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2007

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

Authorized official

Name
Dr. Kevin Groom, PHDNPI 1184717027
Title
Owner
Phone
(850) 433-1656

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X NU Primary

Addresses

Primary practice location

3 W Garden St
Ste 370
Pensacola, FL 32502-5641

Mailing address

229 S Baylen St
Ste 2
Pensacola, FL 32502-5852
Phone (850) 433-1656

National Provider Directory

National Provider Directory

Locations

229 S Baylen St
Ste 2
Pensacola, FL 32502
Phone (850) 433-1656

3 W Garden St
Ste 370
Pensacola, FL 32502
Phone (850) 380-1202

Practitioners & affiliated clinicians

Practitioners 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1166054400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193011200000",
    "number": "1730241209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "229 S BAYLEN ST",
            "address_2": "STE 2",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325025852",
            "telephone_number": "850-433-1656",
            "fax_number": "850-433-1996"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 W GARDEN ST",
            "address_2": "STE 370",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325025641",
            "telephone_number": "850-433-1656",
            "fax_number": "850-433-1996"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENSACOLA PSYCHOLOGICAL CLINIC PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-14",
        "last_updated": "2007-10-22",
        "status": "A",
        "authorized_official_last_name": "GROOM",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "850-433-1656",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pensacola, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2007; 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.