Provider Demographics
NPI:1184849325
Name:PLAZA THERAPY ASSOCIATES, INC.
Entity Type:Organization
Organization Name:PLAZA THERAPY ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:RONALD
Authorized Official - Last Name:LEROM
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:813-281-9383
Mailing Address - Street 1:5201 W KENNEDY BLVD
Mailing Address - Street 2:SUITE 620
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-1845
Mailing Address - Country:US
Mailing Address - Phone:813-281-9383
Mailing Address - Fax:813-349-1766
Practice Address - Street 1:5201 W KENNEDY BLVD
Practice Address - Street 2:SUITE 620
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-1845
Practice Address - Country:US
Practice Address - Phone:813-281-9383
Practice Address - Fax:813-349-1766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0004407103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL73686Medicare ID - Type UnspecifiedPSYCHOLOGIST