Provider Demographics
NPI:1467513788
Name:SUCCESS 4 KIDS & FAMILIES
Entity Type:Organization
Organization Name:SUCCESS 4 KIDS & FAMILIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:C
Authorized Official - Last Name:JEFFRE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:813-871-7412
Mailing Address - Street 1:2902 N ARMENIA AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-1660
Mailing Address - Country:US
Mailing Address - Phone:813-490-5490
Mailing Address - Fax:813-490-5495
Practice Address - Street 1:2902 N ARMENIA AVE
Practice Address - Street 2:STE 200
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-1660
Practice Address - Country:US
Practice Address - Phone:813-490-5490
Practice Address - Fax:813-490-5495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X
FL1329AD353201251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL913554500Medicaid
FL008256400Medicaid