Provider Demographics
NPI:1518373521
Name:NEURO-REHAB PSYCHOLOGY GROUP OF TAMPA, LLC
Entity Type:Organization
Organization Name:NEURO-REHAB PSYCHOLOGY GROUP OF TAMPA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:B
Authorized Official - Last Name:AYALA-FELICIANO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:787-249-4600
Mailing Address - Street 1:4400 W SPRUCE ST
Mailing Address - Street 2:#105
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-4149
Mailing Address - Country:US
Mailing Address - Phone:787-249-4600
Mailing Address - Fax:
Practice Address - Street 1:4400 W SPRUCE ST
Practice Address - Street 2:105
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-4149
Practice Address - Country:US
Practice Address - Phone:787-249-4600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-10
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamilyGroup - Multi-Specialty
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth ServiceGroup - Multi-Specialty
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitationGroup - Multi-Specialty