MEDICARE: NEW TAMPA BEHAVIORAL HEALTH, 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	101YM0800X	Mental Health Counselor	MH 4942	FL
2	103TS0200X	School Psychologist	SS 974	FL
3	252Y00000X	Early Intervention Provider Agency		FL
4	103K00000X	Behavior Analyst	1-03-1200	FL

General Provider Information

NPI Number	:	1518974476
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW TAMPA BEHAVIORAL HEALTH, INC.

Provider Business Mailing Address
First Line	:	PO BOX 46206
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33646
Country	:	US
Telephone Number	:	813-382-2056
Fax Number	:	813-200-3949

Provider Business Practice Location Address
First Line	:	8532 CANTERBURY LAKE BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33619-6674
Country	:	US
Telephone Number	:	813-382-2056
Fax Number	:	813-200-3949

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. JONATHAN A WORCESTER
Credential	:	PH.D., NCSP, BCBA-D
Telephone Number	:	813-382-2056

Provider Enumeration Date	:	08/02/2006
Last Update Date	:	07/02/2011

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