Individual
DR. JOHN T SUPER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
9906 E STATE ROAD 64, BRADENTON, FL 34212-5303
(941) 708-5306
(941) 708-5357
Mailing address
9906 E STATE ROAD 64, BRADENTON, FL 34212-5303
(941) 708-5306
(941) 708-5357
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PY4440
FL
Other
Enumeration date
07/03/2006
Last updated
02/07/2013
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