Provider Demographics
NPI:1942237177
Name:UNIVERSITY PSYCHOTHERAPY GROUP PA
Entity Type:Organization
Organization Name:UNIVERSITY PSYCHOTHERAPY GROUP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:P
Authorized Official - Last Name:CALLAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:813-980-3488
Mailing Address - Street 1:11700 N 58TH ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33617-1692
Mailing Address - Country:US
Mailing Address - Phone:813-980-3488
Mailing Address - Fax:813-980-3647
Practice Address - Street 1:11700 N 58TH ST
Practice Address - Street 2:SUITE C
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33617-1692
Practice Address - Country:US
Practice Address - Phone:813-980-3488
Practice Address - Fax:813-980-3647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW17851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ4276Medicare ID - Type Unspecified