Healthcare Provider Details

I. General information

NPI: 1609185453
Provider Name (Legal Business Name): THOMAS GEORGE ECONOMOS LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2010
Last Update Date: 05/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4144 N ARMENIA AVE SUITE 350
TAMPA FL
33607-6400
US

IV. Provider business mailing address

4144 N ARMENIA AVE SUITE 350
TAMPA FL
33607-6400
US

V. Phone/Fax

Practice location:
  • Phone: 813-728-7925
  • Fax: 813-443-2587
Mailing address:
  • Phone: 813-728-7925
  • Fax: 813-443-2587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberSW7468
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License NumberSW7468
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW7468
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberSW7468
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberSW7468
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License NumberMPH
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: