Provider Demographics
NPI:1316567472
Name:RADICALLY OPEN DBT TAMPA
Entity Type:Organization
Organization Name:RADICALLY OPEN DBT TAMPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:A
Authorized Official - Last Name:ISON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:813-602-2312
Mailing Address - Street 1:2005 PAN AM CIR STE 120
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-2529
Mailing Address - Country:US
Mailing Address - Phone:813-602-2312
Mailing Address - Fax:813-302-1173
Practice Address - Street 1:2005 PAN AM CIR STE 120
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-2529
Practice Address - Country:US
Practice Address - Phone:813-602-2312
Practice Address - Fax:813-302-1173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-19
Last Update Date:2023-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty