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General NPI Number Information
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NPI Number | 1104034735
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Entity Type | Organization
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Legal Business Name | INDIVIDUAL & FAMILY SERVICES INC
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Dates
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Enumeration Date | 05/18/2007
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 2401 W BAY DR BLDG 100 SUITE 117
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City | LARGO
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State | FL
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Zip | 33770-4900
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Country | US
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Telephone | 727-584-4437
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Fax | 727-559-9824
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Provider Business Mailing Address
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Address Line | 2401 W BAY DR BLDG 100 SUITE 117
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City | LARGO
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State | FL
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Zip | 33770-4900
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Country | US
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Telephone | 727-584-4437
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Fax | 727-559-9824
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Authorized Official
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Title or Position | OWNER
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Name | KENNETH ROSEN
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Credential | MS LMHC
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Telephone | 727-584-4437
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MT1250
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License Number State | FL
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