Provider Demographics
NPI:1609185453
Name:ECONOMOS, THOMAS GEORGE (LCSW)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:GEORGE
Last Name:ECONOMOS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4144 N ARMENIA AVE
Mailing Address - Street 2:SUITE 350
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6400
Mailing Address - Country:US
Mailing Address - Phone:813-728-7925
Mailing Address - Fax:813-443-2587
Practice Address - Street 1:4144 N ARMENIA AVE
Practice Address - Street 2:SUITE 350
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6400
Practice Address - Country:US
Practice Address - Phone:813-728-7925
Practice Address - Fax:813-443-2587
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-28
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW7468101YA0400X, 102L00000X, 1041C0700X, 106H00000X, 171M00000X
FLMPH174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No174H00000XOther Service ProvidersHealth Educator