Provider Demographics
NPI:1851648315
Name:SISSON, TREVOR JOHN (MSW)
Entity Type:Individual
Prefix:MR
First Name:TREVOR
Middle Name:JOHN
Last Name:SISSON
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1412 TECH BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-7865
Mailing Address - Country:US
Mailing Address - Phone:813-310-1436
Mailing Address - Fax:
Practice Address - Street 1:1412 TECH BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-7865
Practice Address - Country:US
Practice Address - Phone:813-310-1436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-14
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical