Provider Demographics
NPI:1679192918
Name:PASCO FAMILY PSYCHOLOGICAL SERVICES LLC
Entity Type:Organization
Organization Name:PASCO FAMILY PSYCHOLOGICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST, BEHAVIOR ANALYST
Authorized Official - Prefix:DR
Authorized Official - First Name:NASRIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ERFANIAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, BCBA-D
Authorized Official - Phone:813-553-7675
Mailing Address - Street 1:19439 SHUMARD OAK DR UNIT 102
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34638-7277
Mailing Address - Country:US
Mailing Address - Phone:813-553-7675
Mailing Address - Fax:813-553-7337
Practice Address - Street 1:19439 SHUMARD OAK DR UNIT 102
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34638-7277
Practice Address - Country:US
Practice Address - Phone:813-553-7675
Practice Address - Fax:813-553-7337
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NASRIN ERFANIAN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-04-15
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1568776870OtherNPPES