Provider Demographics
NPI:1790253508
Name:BEHAVIORAL HEALTH OF SOUTH TAMPA
Entity Type:Organization
Organization Name:BEHAVIORAL HEALTH OF SOUTH TAMPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:BARROR-LEVINE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:813-758-3754
Mailing Address - Street 1:902 N ARMENIA AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-1707
Mailing Address - Country:US
Mailing Address - Phone:813-758-3754
Mailing Address - Fax:813-879-2610
Practice Address - Street 1:902 N ARMENIA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-1707
Practice Address - Country:US
Practice Address - Phone:
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-09
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health