Organization
LIFESPAN PSYCHOLOGY SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ATHENA BOOLUKOS GORDON ED.M., PSY.D. (PRESIDENT)
(617) 784-0771
Entity
Organization
Contact information
Practice address
4201 BAYSHORE BLVD, UNIT 1603, TAMPA, FL 33611-1669
(617) 784-0771
Mailing address
4201 BAYSHORE BLVD, UNIT 1603, TAMPA, FL 33611-1669
(617) 784-0771
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
Other
Enumeration date
05/30/2012
Last updated
05/30/2012
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