Healthcare Provider Details

I. General information

NPI: 1467767178
Provider Name (Legal Business Name): PREMIER PSYCHOLOGICAL SERVICES, PL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2010
Last Update Date: 08/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 W BEARSS AVE STE B
TAMPA FL
33613-1228
US

IV. Provider business mailing address

322 W BEARSS AVE
TAMPA FL
33613-1228
US

V. Phone/Fax

Practice location:
  • Phone: 888-899-7736
  • Fax:
Mailing address:
  • Phone: 888-899-7736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberPY7877
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY7877
License Number StateFL

VIII. Authorized Official

Name: DR. BRAD PALERMO
Title or Position: LICENSED PSYCHOLOGIST, MEMBER
Credential:
Phone: 888-899-7736