Provider Demographics
NPI:1669506671
Name:CLINICAL PSYCHOLOGY ASSOCIATES OF TAMPA BAY, INC
Entity Type:Organization
Organization Name:CLINICAL PSYCHOLOGY ASSOCIATES OF TAMPA BAY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHERROLYN
Authorized Official - Middle Name:CATRECE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:813-657-0488
Mailing Address - Street 1:PO BOX 2288
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33509-2288
Mailing Address - Country:US
Mailing Address - Phone:813-657-0488
Mailing Address - Fax:352-518-0063
Practice Address - Street 1:1210 MILLENNIUM PKWY
Practice Address - Street 2:SUITE 1033
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-4896
Practice Address - Country:US
Practice Address - Phone:813-657-0488
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty