| Eileen Gustafson Lcsw Pa | |
|
10335 Cross Creek Blvd Suite 23 Tampa FL 33647-2795 | |
| (352) 428-8463 | |
| (352) 597-2074 |
| Full Name | Eileen Gustafson Lcsw Pa |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 10335 Cross Creek Blvd, Tampa, Florida |
| Authorized Official Name and Position | Eileen Gustafson (OWNER/THERAPIST) |
| Authorized Official Contact | 3524288463 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Eileen Gustafson Lcsw Pa Po Box 5797 Spring Hill FL 34611-5797 Ph: (352) 428-8463 | Eileen Gustafson Lcsw Pa 10335 Cross Creek Blvd Suite 23 Tampa FL 33647-2795 Ph: (352) 428-8463 |
| NPI Number | 1396933446 |
|---|---|
| Provider Enumeration Date | 10/12/2007 |
| Last Update Date | 08/12/2008 |
| Medicare PECOS PAC ID | 4183633894 |
|---|---|
| Medicare Enrollment ID | O20060419000741 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396933446 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | LCSW 6283 (Florida) | Primary |
| Provider Name | Eileen S Gustafson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1477545846 PECOS PAC ID: 1254397813 Enrollment ID: I20041206000304 |
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