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8910 N Dale Mabry Hwy Suite 12 Tampa FL 33614-1591 | |
| (813) 422-0073 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 8910 N Dale Mabry Hwy, Tampa, Florida |
| Authorized Official Name and Position | Alexander Smith (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 8134220073 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
8910 N Dale Mabry Hwy Suite 12 Tampa FL 33614-1591 Ph: (813) 422-0073 | 8910 N Dale Mabry Hwy Suite 12 Tampa FL 33614-1591 Ph: (813) 422-0073 |
| NPI Number | 1134548837 |
|---|---|
| Provider Enumeration Date | 04/09/2014 |
| Last Update Date | 04/09/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134548837 | NPI | - | NPPES |
| 766714100 | Medicaid | FL | |
| HK291A | Other | FL | MEDICAIRE PTAN |
| 1114268521 | Other | FL | INDIVIDUAL NPI |
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