Provider Demographics
NPI:1780096677
Name:VIRGINIA SLOAN, PHD
Entity type:Organization
Organization Name:VIRGINIA SLOAN, PHD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:W
Authorized Official - Last Name:SLOAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:352-283-9409
Mailing Address - Street 1:PO BOX 358857
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32635-8857
Mailing Address - Country:US
Mailing Address - Phone:352-283-9409
Mailing Address - Fax:352-377-3193
Practice Address - Street 1:1505 NW 16TH AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4036
Practice Address - Country:US
Practice Address - Phone:352-283-9409
Practice Address - Fax:352-377-3193
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VIRGINIA SLOAN, PHD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-05-27
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5712103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL54454AMedicare UPIN