Healthcare Provider Details

I. General information

NPI: 1346738705
Provider Name (Legal Business Name): TAMPA PSYCHOLOGY GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2018
Last Update Date: 06/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1463 OAKFIELD DR STE 109
BRANDON FL
33511
US

IV. Provider business mailing address

11111 SILVER DANCER DR
RIVERVIEW FL
33579-2354
US

V. Phone/Fax

Practice location:
  • Phone: 813-992-1880
  • Fax: 813-235-4181
Mailing address:
  • Phone: 813-210-2355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State

VIII. Authorized Official

Name: ROCHELLE TAORMINA
Title or Position: LICENSED PSYCHOLOGIST
Credential: PHD
Phone: 813-210-2355