Healthcare Provider Details

I. General information

NPI: 1306833140
Provider Name (Legal Business Name): ANTHONY MICHAEL HASSAN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8415 BAYSHORE BLVD MACDILL AFB
TAMPA FL
33621-1607
US

IV. Provider business mailing address

19135 CYPRESS REACH LN
TAMPA FL
33647-3605
US

V. Phone/Fax

Practice location:
  • Phone: 813-827-9186
  • Fax: 813-828-6868
Mailing address:
  • Phone: 813-827-9186
  • Fax: 813-828-6868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW3953
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: