Provider Demographics
NPI:1275024382
Name:FLORIDA CENTER FOR INTEGRATIVE TELEPSYCHIATRY AND TELEPSYCHOTHERAPY
Entity Type:Organization
Organization Name:FLORIDA CENTER FOR INTEGRATIVE TELEPSYCHIATRY AND TELEPSYCHOTHERAPY
Other - Org Name:FCITT
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ELI
Authorized Official - Middle Name:
Authorized Official - Last Name:KOLP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-798-8379
Mailing Address - Street 1:1604 3RD STREET CIR E
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:FL
Mailing Address - Zip Code:34221-4285
Mailing Address - Country:US
Mailing Address - Phone:727-798-8379
Mailing Address - Fax:
Practice Address - Street 1:1604 3RD STREET CIR E
Practice Address - Street 2:
Practice Address - City:PALMETTO
Practice Address - State:FL
Practice Address - Zip Code:34221-4285
Practice Address - Country:US
Practice Address - Phone:727-798-8379
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-24
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty