Provider Demographics
NPI:1346079845
Name:STAR PSYCHOLOGY, LLC
Entity type:Organization
Organization Name:STAR PSYCHOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHEYTOPHIA
Authorized Official - Middle Name:R
Authorized Official - Last Name:CUNHA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:954-882-5734
Mailing Address - Street 1:2258 COACHMAN LOOP
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33812-4047
Mailing Address - Country:US
Mailing Address - Phone:954-882-5734
Mailing Address - Fax:
Practice Address - Street 1:4720 CLEVELAND HEIGHTS BLVD STE 201
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-2245
Practice Address - Country:US
Practice Address - Phone:954-882-5734
Practice Address - Fax:863-225-8136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Multi-Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Multi-Specialty