Healthcare Provider Details

I. General information

NPI: 1932398435
Provider Name (Legal Business Name): DEPARTMENT OF VETERANS AFFAIRS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2007
Last Update Date: 10/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10770 N 46TH ST SUITE A-400
TAMPA FL
33617-3442
US

IV. Provider business mailing address

10770 N 46TH ST SUITE A-400
TAMPA FL
33617-3442
US

V. Phone/Fax

Practice location:
  • Phone: 813-610-5879
  • Fax: 813-228-2857
Mailing address:
  • Phone: 813-610-5879
  • Fax: 813-228-2857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberSW8815
License Number StateFL

VIII. Authorized Official

Name: MR. HARRY JOHN MCCURDY
Title or Position: SOCIAL SCIENCE PROGRAM SPECIALIST
Credential: LCSW
Phone: 813-610-5879