Provider Demographics
NPI:1366509333
Name:NEW TAMPA PSYCHOLOGICAL SERVICES, INC.
Entity Type:Organization
Organization Name:NEW TAMPA PSYCHOLOGICAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TSILA
Authorized Official - Middle Name:ABUSH
Authorized Official - Last Name:KIRSH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:813-312-1005
Mailing Address - Street 1:16303 TURNBRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-2740
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15310 AMBERLY DR
Practice Address - Street 2:SUITE 250
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-2199
Practice Address - Country:US
Practice Address - Phone:813-312-1005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6935103T00000X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL74154OtherBCBS PROVIDER NUMBER
FL74154AMedicare ID - Type Unspecified