Provider Demographics
NPI:1326194838
Name:CLINICAL SERVICE ASSOCIATES INC
Entity Type:Organization
Organization Name:CLINICAL SERVICE ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:DUNN
Authorized Official - Last Name:KASTNER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:813-978-3960
Mailing Address - Street 1:3500 E FLETCHER AVE
Mailing Address - Street 2:S129
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613
Mailing Address - Country:US
Mailing Address - Phone:813-978-3960
Mailing Address - Fax:813-978-0475
Practice Address - Street 1:3500 E FLETCHER AVE
Practice Address - Street 2:S129
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613
Practice Address - Country:US
Practice Address - Phone:813-978-3960
Practice Address - Fax:813-978-0475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW34571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z5724Medicare ID - Type Unspecified