Provider Demographics
NPI:1518311398
Name:IREBOOT, LLC
Entity Type:Organization
Organization Name:IREBOOT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CITRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-422-7609
Mailing Address - Street 1:1506 W LEMON ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-1002
Mailing Address - Country:US
Mailing Address - Phone:813-422-7609
Mailing Address - Fax:
Practice Address - Street 1:4511 N HIMES AVE STE 200
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-7085
Practice Address - Country:US
Practice Address - Phone:813-422-7609
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-19
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH12380101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty