Provider Demographics
NPI:1700400827
Name:CLINICAL SERVICE ASSOCIATES
Entity Type:Organization
Organization Name:CLINICAL SERVICE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:D
Authorized Official - Last Name:KASTNER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:813-515-5978
Mailing Address - Street 1:10734 DOWRY AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-3504
Mailing Address - Country:US
Mailing Address - Phone:813-515-5978
Mailing Address - Fax:813-515-5979
Practice Address - Street 1:3812 W LINEBAUGH AVE STE 100
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-8702
Practice Address - Country:US
Practice Address - Phone:813-515-5978
Practice Address - Fax:813-515-5979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-04
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty