MEDICARE: HILLSBOROUGH COUNTY DEPT OF CHILDREN'S SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	322D00000X	Emotionally Disturbed Childrens' Residential Treatment Facility	8006-24	FL

General Provider Information

NPI Number	:	1245241165
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HILLSBOROUGH COUNTY DEPT OF CHILDREN'S SERVICES

Provider Business Mailing Address
First Line	:	3110 CLAY MANGUM LN
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33618-2501
Country	:	US
Telephone Number	:	813-264-3807
Fax Number	:	813-264-3872

Provider Business Practice Location Address
First Line	:	3110 CLAY MANGUM LN
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33618-2501
Country	:	US
Telephone Number	:	813-264-3807
Fax Number	:	813-264-3872

Authorized Official
Title or Position	:	CLINICAL SERVICES DIRECTOR
Name	:	DR. CHARLES D. FURMAN III
Credential	:	PSY.D.
Telephone Number	:	813-264-3807

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	08/22/2020

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Practice Location Address:

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Directions to “HILLSBOROUGH COUNTY DEPT OF CHILDREN'S SERVICES ” Practice Location

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