| Ben C. Ghozali, Psy.d., P.a. | |
|
1227 S Myrtle Ave Clearwater FL 33756-3469 | |
| (727) 449-2628 | |
| (727) 466-0478 |
| Full Name | Ben C. Ghozali, Psy.d., P.a. |
|---|---|
| Speciality | Psychologist |
| Location | 1227 S Myrtle Ave, Clearwater, Florida |
| Authorized Official Name and Position | Ben Ghozali (PRESIDENT) |
| Authorized Official Contact | 8132158348 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ben C. Ghozali, Psy.d., P.a. 1227 S Myrtle Ave Clearwater FL 33756-3469 Ph: (727) 449-2628 | Ben C. Ghozali, Psy.d., P.a. 1227 S Myrtle Ave Clearwater FL 33756-3469 Ph: (727) 449-2628 |
| NPI Number | 1437388915 |
|---|---|
| Provider Enumeration Date | 07/06/2009 |
| Last Update Date | 07/06/2009 |
| Medicare PECOS PAC ID | 7012141021 |
|---|---|
| Medicare Enrollment ID | O20131007000590 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437388915 | NPI | - | NPPES |
| 73121 | Other | FL | BLUE CROSS/BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | PY6738 (Florida) | Primary |
| Provider Name | Ben C Ghozali |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1689734337 PECOS PAC ID: 0244263028 Enrollment ID: I20050913000382 |
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