Provider Demographics
NPI:1417111782
Name:ESTE LOGIC, P.A.
Entity Type:Organization
Organization Name:ESTE LOGIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ESTELA
Authorized Official - Middle Name:
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:813-728-3521
Mailing Address - Street 1:4020 SUN CITY CENTER BLVD
Mailing Address - Street 2:SUITE 11
Mailing Address - City:SUN CITY CENTER
Mailing Address - State:FL
Mailing Address - Zip Code:33573-5285
Mailing Address - Country:US
Mailing Address - Phone:813-634-4700
Mailing Address - Fax:813-634-4703
Practice Address - Street 1:4020 SUN CITY CENTER BLVD
Practice Address - Street 2:SUITE 11
Practice Address - City:SUN CITY CENTER
Practice Address - State:FL
Practice Address - Zip Code:33573-5285
Practice Address - Country:US
Practice Address - Phone:813-634-4700
Practice Address - Fax:813-634-4703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-15
Last Update Date:2012-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6533103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FV314AMedicare UPIN