Active NPI
David Brockway, PSY.D
- Psychologist
- St Petersburg, FL
National Provider Identifier
1821494022
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 0471010316
- Practice address
- 3730 18TH Ave N
St Petersburg, FL 33713-4816 - Phone
- (727) 666-2429
- NPI assigned
- Nov 15, 2014
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychoanalyst | 102L00000X | 102L00000X | VT | |
| Psychologist | 103T00000X | 0471010316 | FL | Primary |
Addresses
Primary practice location
3730 18TH Ave N
St Petersburg, FL 33713-4816
Mailing address
3730 18TH Ave N
St Petersburg, FL 33713-4816
Phone (727) 666-2429
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 102L00000X | VT | MD | Psychoanalyst |
| 0471010316 | FL | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1416009600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1463616000000",
"number": "1821494022",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3730 18TH AVE N",
"city": "ST PETERSBURG",
"state": "FL",
"postal_code": "337134816",
"telephone_number": "727-666-2429"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3730 18TH AVE N",
"city": "ST PETERSBURG",
"state": "FL",
"postal_code": "337134816",
"telephone_number": "727-666-2429"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROCKWAY",
"first_name": "DAVID",
"credential": "PSY.D",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-11-15",
"last_updated": "2016-05-19",
"status": "A"
},
"taxonomies": [
{
"code": "102L00000X",
"taxonomy_group": "",
"desc": "Psychoanalyst",
"state": "VT",
"license": "102L00000X",
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "FL",
"license": "0471010316",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in St Petersburg, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.