MEDICARE: NEW TAMPA PSYCHOLOGICAL SERVICES, INC.

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	103T00000X	Psychologist	PY6935	FL
2	103TC2200X	Clinical Child & Adolescent Psychologist	PY6935	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	74154	OTHER	FL	BCBS PROVIDER NUMBER

General Provider Information

NPI Number	:	1366509333
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW TAMPA PSYCHOLOGICAL SERVICES, INC.

Provider Business Mailing Address
First Line	:	16303 TURNBRIDGE CT
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-2740
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	15310 AMBERLY DR
Second Line	:	SUITE 250
City	:	TAMPA
State	:	FL
Zip	:	33647-2199
Country	:	US
Telephone Number	:	813-312-1005
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. TSILA ABUSH KIRSH
Credential	:	PH.D.
Telephone Number	:	813-312-1005

Provider Enumeration Date	:	01/02/2007
Last Update Date	:	09/11/2025

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