MEDICARE: JONATHAN SOBIN PSY.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	103TC1900X	Counseling Psychologist	PY 8611	FL
2	103TC0700X	Clinical Psychologist	PY 8611	FL

General Provider Information

NPI Number	:	1447368881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN SOBIN PSY.D.

Provider Business Mailing Address
First Line	:	2934 W KNIGHTS AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33611-1622
Country	:	US
Telephone Number	:	813-444-9163
Fax Number	:	813-444-9163

Provider Business Practice Location Address
First Line	:	4230 S MACDILL AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33611-1901
Country	:	US
Telephone Number	:	813-444-9163
Fax Number	:	813-444-9163

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

Provider Enumeration Date	:	08/27/2006
Last Update Date	:	03/28/2013

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