Provider Demographics
NPI:1437388915
Name:BEN C. GHOZALI, PSY.D., P.A.
Entity Type:Organization
Organization Name:BEN C. GHOZALI, PSY.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GHOZALI
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:813-215-8348
Mailing Address - Street 1:1227 S MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-3469
Mailing Address - Country:US
Mailing Address - Phone:727-449-2628
Mailing Address - Fax:727-466-0478
Practice Address - Street 1:1227 S MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3469
Practice Address - Country:US
Practice Address - Phone:727-449-2628
Practice Address - Fax:727-466-0478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-06
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6738103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL73121OtherBLUE CROSS/BLUE SHIELD