Provider Demographics
NPI:1275782625
Name:AFRIN, SUJANA
Entity Type:Individual
Prefix:
First Name:SUJANA
Middle Name:
Last Name:AFRIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 W. BUSCH BLVD,
Mailing Address - Street 2:SUITE B
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612
Mailing Address - Country:US
Mailing Address - Phone:813-770-2953
Mailing Address - Fax:813-774-2477
Practice Address - Street 1:1910 W. BUSCH BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612
Practice Address - Country:US
Practice Address - Phone:813-770-2953
Practice Address - Fax:813-774-2477
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-10
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
FLIMH12202101YM0800X
IMH12202101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker