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General NPI Number Information
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NPI Number | 1659620409
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Entity Type | Organization
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Legal Business Name | CARMEN I TOZZO PA
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Dates
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Enumeration Date | 09/06/2012
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Last Update Date | 10/28/2015
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Provider Practice Location Address
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Address Line | 630 N MAIN ST
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City | WILLISTON
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State | FL
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Zip | 32696-1705
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Country | US
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Telephone | 352-529-2570
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Fax | 352-529-2570
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Provider Business Mailing Address
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Address Line | PO BOX 817
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City | WILLISTON
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State | FL
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Zip | 32696-0817
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Country | US
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Telephone | 352-318-2339
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Fax | 352-419-6310
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CARMEN I TOZZO
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Credential | PH,D.
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Telephone | 352-318-2339
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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 | PY5911
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License Number State | FL
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