Provider Demographics
NPI:1346738705
Name:TAMPA PSYCHOLOGY GROUP
Entity Type:Organization
Organization Name:TAMPA PSYCHOLOGY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ROCHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:TAORMINA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:813-210-2355
Mailing Address - Street 1:11111 SILVER DANCER DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33579-2354
Mailing Address - Country:US
Mailing Address - Phone:813-210-2355
Mailing Address - Fax:
Practice Address - Street 1:1463 OAKFIELD DR STE 109
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511
Practice Address - Country:US
Practice Address - Phone:813-992-1880
Practice Address - Fax:813-235-4181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-01
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016590900Medicaid