Provider Demographics
NPI:1952829137
Name:CHILD AND ADOLESCENT TAMPA BAY PSYCHIATRY, LLC
Entity Type:Organization
Organization Name:CHILD AND ADOLESCENT TAMPA BAY PSYCHIATRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ONELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMIREZ-COOK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-766-4218
Mailing Address - Street 1:12231 MAIN ST UNIT 1196
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:FL
Mailing Address - Zip Code:33576-7253
Mailing Address - Country:US
Mailing Address - Phone:813-440-2741
Mailing Address - Fax:813-338-4490
Practice Address - Street 1:100 S ASHLEY DR STE 600
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33602-5300
Practice Address - Country:US
Practice Address - Phone:813-766-4218
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-07
Last Update Date:2017-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1127202084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL00544800Medicaid
12662244OtherCAQH
1669639001OtherINDIVIDUAL NPI
2084P0800XOtherINDIVIDUAL TAXONOMY
FLME112720OtherLICENSE NUMBER