Professional Psychological Services of Florida

Primary specialty

PsychologistTaxonomy code 103T00000X

Legal business name

PROFESSIONAL PSYCHOLOGICAL SERVICES OF FLORIDA

Practice address

15525 Starling Crossing Dr
Lithia, FL 33547-4021

Phone

(813) 351-9235

NPI assigned

Jan 30, 2020

Organization subpart

No

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

Authorized official

Name

Robert Joseph Klukoff, PSY.D.NPI 1104130335

Title

Psychologist

Phone

(813) 351-9235

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Practitioners 2

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

• Robert Joseph Klukoff, PSY.D

  • Psychologist
  • Gibsonton, FL
  • NPI 1104130335
  Medicare reassignment NPD Authorized official
• Kate Davids, PSY.D.

  • Psychologist
  • Wesley Chapel, FL
  • NPI 1902842289
  NPD (past)

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

{
    "created_epoch": "1580342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1581292800000",
    "number": "1821629593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 441",
            "city": "LITHIA",
            "state": "FL",
            "postal_code": "335470441",
            "telephone_number": "813-351-9235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15525 STARLING CROSSING DR",
            "city": "LITHIA",
            "state": "FL",
            "postal_code": "335474021",
            "telephone_number": "813-351-9235"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL PSYCHOLOGICAL SERVICES OF FLORIDA",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-30",
        "last_updated": "2020-02-10",
        "certification_date": "2020-02-10",
        "status": "A",
        "authorized_official_last_name": "KLUKOFF",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "PSYCHOLOGIST",
        "authorized_official_telephone_number": "813-351-9235",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Lithia",
            "affiliation": "N",
            "address_1": "15525 Starling Crossing Dr",
            "city": "Lithia",
            "state": "FL",
            "country_code": "US",
            "postal_code": "335474021",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Donna M Poth, SLP
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• Layne Alexandria Pullen
• Kailey Quintana, PA-C
• Patricia DO Vale Rabon, PA

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2020; 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.