Healthcare Provider Details

I. General information

NPI: 1275605693
Provider Name (Legal Business Name): PSYCHIATRY AND PSYCHOTHERAPY ASSOCIATES CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 09/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10225 ULMERTON RD SUITE 8-B
LARGO FL
33771-3538
US

IV. Provider business mailing address

10225 ULMERTON RD SUITE 8-B
LARGO FL
33771-3538
US

V. Phone/Fax

Practice location:
  • Phone: 727-586-0636
  • Fax: 727-585-6287
Mailing address:
  • Phone: 727-586-0636
  • Fax: 727-585-6287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ANGELA J GIBSON
Title or Position: LCSW
Credential: MSW
Phone: 727-586-0636