Provider Demographics
NPI:1558567602
Name:PALERMO, BRAD (PSYD, LICENSED PSY)
Entity Type:Individual
Prefix:DR
First Name:BRAD
Middle Name:
Last Name:PALERMO
Suffix:
Gender:M
Credentials:PSYD, LICENSED PSY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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 1:322 W BEARSS AVE
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:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 7877103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical