MEDICARE: ANGELA M MCBRIDE PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103G00000X	Clinical Neuropsychologist	PY6803	FL
2	103TC0700X	Clinical Psychologist	PY6803	FL

General Provider Information

NPI Number	:	1093755399
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA M MCBRIDE PH.D.

Provider Business Mailing Address
First Line	:	2602 W CYPRESS ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-1723
Country	:	US
Telephone Number	:	813-350-9333
Fax Number	:	813-350-9666

Provider Business Practice Location Address
First Line	:	2602 W CYPRESS ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-1723
Country	:	US
Telephone Number	:	813-350-9333
Fax Number	:	813-350-9666

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	02/02/2009

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