| Entity Name: | LEVERMORE PSYCHOLOGICAL SERVICES, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 01 Aug 2002 (22 years ago) |
| Document Number: | P02000083521 |
| FEI/EIN Number | 510418205 |
| Address: | 6900 Tavistock Lakes Blvd., Orlando, FL, 32827, US |
| Mail Address: | 6900 Tavistock Lakes Blvd., Orlando, FL, 32827, US |
| ZIP code: | 32827 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1639339609 | 2008-06-13 | 2008-06-13 | 15715 S DIXIE HWY, SUITE 334, PALMETTO BAY, FL, 331571800, US | 15715 S DIXIE HWY, SUITE 334, PALMETTO BAY, FL, 331571800, US | |||||||||||||||||
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| Phone | +1 305-763-9095 |
Authorized person
| Name | DR. MONIQUE LEVERMORE |
| Role | PRESIDENT/LICENSED CLINICAL PSYCHOL |
| Phone | 3057639095 |
Taxonomy
| Taxonomy Code | 103TC0700X - Clinical Psychologist |
| License Number | PY 5628 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| LEVERMORE MONIQUE A | Agent | 6900 Tavistock Lakes Blvd., Orlando, FL, 32827 |
| Name | Role | Address |
|---|---|---|
| LEVERMORE MONIQUE A | President | 6900 Tavistock Lakes Blvd., Orlando, FL, 32827 |
| Name | Role | Address |
|---|---|---|
| LEVERMORE MONIQUE A | Director | 6900 Tavistock Lakes Blvd., Orlando, FL, 32827 |
| LEVERMORE CLAUDETTE | Director | 6900 Tavistock Lakes Blvd., Orlando, FL, 32827 |
| Name | Role | Address |
|---|---|---|
| LEVERMORE CLAUDETTE | Treasurer | 6900 Tavistock Lakes Blvd., Orlando, FL, 32827 |
Date of last update: 01 Jan 2025
Sources: Florida Department of State
