Provider Demographics
NPI:1982316303
Name:GRACE PSYCHOLOGICAL SERVICES, LLC
Entity type:Organization
Organization Name:GRACE PSYCHOLOGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:ALVES
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:727-314-5001
Mailing Address - Street 1:1913 TYRONE BLVD N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-4841
Mailing Address - Country:US
Mailing Address - Phone:727-314-2560
Mailing Address - Fax:
Practice Address - Street 1:1913 TYRONE BLVD N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-4841
Practice Address - Country:US
Practice Address - Phone:727-314-2560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-16
Last Update Date:2023-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
593Q2OtherFLORIDA BLUE
3963857OtherCIGNA