Provider Demographics
NPI:1992323778
Name:MOTHERMIND PSYCHOLOGY
Entity type:Organization
Organization Name:MOTHERMIND PSYCHOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HENANDEZ POUDEVIDA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:813-400-0375
Mailing Address - Street 1:19105 N US HIGHWAY 41 STE 300
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33549-4206
Mailing Address - Country:US
Mailing Address - Phone:813-400-0375
Mailing Address - Fax:813-616-6818
Practice Address - Street 1:19105 N US HIGHWAY 41 STE 300
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33549-4206
Practice Address - Country:US
Practice Address - Phone:813-400-0375
Practice Address - Fax:813-616-6818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-08
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty