Provider Demographics
NPI:1467767178
Name:PREMIER PSYCHOLOGICAL SERVICES, PL
Entity Type:Organization
Organization Name:PREMIER PSYCHOLOGICAL SERVICES, PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST, MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:PALERMO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-899-7736
Mailing Address - Street 1:322 W BEARSS AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-1228
Mailing Address - Country:US
Mailing Address - Phone:888-899-7736
Mailing Address - Fax:
Practice Address - Street 1:324 W BEARSS AVE STE B
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-1228
Practice Address - Country:US
Practice Address - Phone:888-899-7736
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-18
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7877103TC0700X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
EW435AMedicare UPIN