Provider Demographics
NPI:1235537184
Name:MENTAL HEALTH ASSOCIATES OF TAMPA BAY, INC.
Entity Type:Organization
Organization Name:MENTAL HEALTH ASSOCIATES OF TAMPA BAY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:A
Authorized Official - Last Name:CARUSO
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:352-243-1319
Mailing Address - Street 1:3632 HAWKSHEAD DR
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-6940
Mailing Address - Country:US
Mailing Address - Phone:352-243-1319
Mailing Address - Fax:
Practice Address - Street 1:3632 HAWKSHEAD DR
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-6940
Practice Address - Country:US
Practice Address - Phone:352-243-1319
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-09
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW1344261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)