Provider Demographics
NPI:1154403228
Name:KROUNGOLD, MITCHELL (PHD)
Entity type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:
Last Name:KROUNGOLD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14236 MARK DR
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33774-5110
Mailing Address - Country:US
Mailing Address - Phone:727-596-9923
Mailing Address - Fax:727-596-9923
Practice Address - Street 1:401 CORBETT ST
Practice Address - Street 2:SUITE 300
Practice Address - City:BELLEAIR
Practice Address - State:FL
Practice Address - Zip Code:33756-7309
Practice Address - Country:US
Practice Address - Phone:727-442-6007
Practice Address - Fax:727-441-3981
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY2366103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL75197Medicare UPIN
FL75197Medicare ID - Type Unspecified59-2438765