Healthcare Provider Details

I. General information

NPI: 1669506671
Provider Name (Legal Business Name): CLINICAL PSYCHOLOGY ASSOCIATES OF TAMPA BAY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 MILLENNIUM PKWY SUITE 1033
BRANDON FL
33511-4896
US

IV. Provider business mailing address

PO BOX 2288
BRANDON FL
33509-2288
US

V. Phone/Fax

Practice location:
  • Phone: 813-657-0488
  • Fax:
Mailing address:
  • Phone: 813-657-0488
  • Fax: 352-518-0063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. CHERROLYN CATRECE SMITH
Title or Position: PRESIDENT
Credential: PHD
Phone: 813-657-0488