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General NPI Number Information
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NPI Number | 1174886600
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Entity Type | Organization
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Legal Business Name | BRANDON PSYCHIATRY AND COUNSELING
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Dates
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Enumeration Date | 06/19/2012
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Last Update Date | 06/22/2012
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Provider Practice Location Address
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Address Line | 401 N PARSONS AVE SUITE 107 A
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City | BRANDON
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State | FL
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Zip | 33510-4538
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Country | US
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Telephone | 813-967-1376
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Fax | 813-681-5958
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Provider Business Mailing Address
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Address Line | 401 N PARSONS AVE SUITE 107 A
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City | BRANDON
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State | FL
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Zip | 33510-4538
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Country | US
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Telephone | 813-967-1376
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Fax | 813-681-5958
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. ELENA ANNA SPANOS
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Credential | M.S.W.
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Telephone | 813-967-1376
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 47310
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2084A0401X
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Taxonomy Name | Addiction Medicine (Psychiatry & Neurology) Physician
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License Number | BK4208016
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW5979
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License Number State | FL
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