Healthcare Provider Details

I. General information

NPI: 1710225685
Provider Name (Legal Business Name): DONNA BERGHAUSER NCSP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2013
Last Update Date: 11/27/2023
Certification Date: 08/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3339 W WYOMING CIR
TAMPA FL
33611-4340
US

IV. Provider business mailing address

3339 W WYOMING CIR
TAMPA FL
33611-4340
US

V. Phone/Fax

Practice location:
  • Phone: 813-658-8413
  • Fax:
Mailing address:
  • Phone: 813-658-8413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberSS1422
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: