Active NPI
Jack Arthur Peverill, PH.D.
- Clinical Child & Adolescent Psychologist
- Osprey, FL
National Provider Identifier
1780875906
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Child & Adolescent Psychologist
- License
- PY 3601
- Practice address
- 2163 South Tamiami Trail
Osprey, FL 34229-9696 - Phone
- (941) 924-6113
- Fax
- (941) 924-6113
- NPI assigned
- Aug 5, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Child & Adolescent Psychologist | 103TC2200X | PY 3601 | FL | Primary |
Addresses
Primary practice location
2163 South Tamiami Trail
Osprey, FL 34229-9696
Mailing address
4724 Acorn Circle
Sarasota, FL 34233-3935
Phone (941) 924-6113
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)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PY 3601 | FL | MD | Clinical Child & Adolescent Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1186272000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1186272000000",
"number": "1780875906",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4724 ACORN CIRCLE",
"city": "SARASOTA",
"state": "FL",
"postal_code": "342333935",
"telephone_number": "941-924-6113",
"fax_number": "941-924-6113"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2163 SOUTH TAMIAMI TRAIL",
"city": "OSPREY",
"state": "FL",
"postal_code": "342299696",
"telephone_number": "941-924-6113",
"fax_number": "941-924-6113"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEVERILL",
"first_name": "JACK",
"middle_name": "ARTHUR",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-08-05",
"last_updated": "2007-08-05",
"status": "A"
},
"taxonomies": [
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "FL",
"license": "PY 3601",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Osprey, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 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.