Provider Demographics
NPI:1528179488
Name:STEPHEN HAWK DO PA
Entity Type:Organization
Organization Name:STEPHEN HAWK DO PA
Other - Org Name:BAY AREA BEHAVIORAL HEALTH ASSOCIATES
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAWK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:727-518-0572
Mailing Address - Street 1:10225 ULMERTON RD
Mailing Address - Street 2:SUITE 4A
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33771-3538
Mailing Address - Country:US
Mailing Address - Phone:727-518-0572
Mailing Address - Fax:727-518-7423
Practice Address - Street 1:10225 ULMERTON RD
Practice Address - Street 2:SUITE 4A
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-3538
Practice Address - Country:US
Practice Address - Phone:727-518-0572
Practice Address - Fax:727-518-7423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS73172084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK3021Medicare ID - Type Unspecified