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General NPI Number Information
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NPI Number | 1093364671
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Entity Type | Individual
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Provider Name | ELIZABETH GAVIN PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 09/06/2019
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Last Update Date | 09/06/2019
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Provider Practice Location Address
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Address Line | 13000 BRUCE B DOWNS BLVD HEALTH & BEHAVIORAL SCIENCES (116A)
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City | TAMPA
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State | FL
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Zip | 33612
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Country | US
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Telephone | 813-631-2517
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Fax |
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Provider Business Mailing Address
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Address Line | 13000 BRUCE B DOWNS BLVD HEALTH & BEHAVIORAL SCIENCES (116A)
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City | TAMPA
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State | FL
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Zip | 33612
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 20043262A
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License Number State | IN
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