Provider Demographics
NPI:1518974476
Name:NEW TAMPA BEHAVIORAL HEALTH, INC.
Entity Type:Organization
Organization Name:NEW TAMPA BEHAVIORAL HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:WORCESTER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, NCSP, BCBA-D
Authorized Official - Phone:813-382-2056
Mailing Address - Street 1:PO BOX 46206
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33646
Mailing Address - Country:US
Mailing Address - Phone:813-382-2056
Mailing Address - Fax:813-200-3949
Practice Address - Street 1:8532 CANTERBURY LAKE BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-6674
Practice Address - Country:US
Practice Address - Phone:813-382-2056
Practice Address - Fax:813-200-3949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2011-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 4942101YM0800X
FL1-03-1200103K00000X
FLSS 974103TS0200X
FL252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Multi-Specialty
No252Y00000XAgenciesEarly Intervention Provider AgencyGroup - Multi-Specialty