Provider Demographics
NPI:1104034735
Name:INDIVIDUAL & FAMILY SERVICES INC
Entity Type:Organization
Organization Name:INDIVIDUAL & FAMILY SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MS LMHC
Authorized Official - Phone:727-584-4437
Mailing Address - Street 1:2401 W BAY DR
Mailing Address - Street 2:BLDG 100 SUITE 117
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33770-4900
Mailing Address - Country:US
Mailing Address - Phone:727-584-4437
Mailing Address - Fax:727-559-9824
Practice Address - Street 1:2401 W BAY DR
Practice Address - Street 2:BLDG 100 SUITE 117
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-4900
Practice Address - Country:US
Practice Address - Phone:727-584-4437
Practice Address - Fax:727-559-9824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT1250106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherTAX IDENTIFICATION