Provider Demographics
NPI:1972927721
Name:DEMASO, JOHANNA (PSYS)
Entity Type:Individual
Prefix:
First Name:JOHANNA
Middle Name:
Last Name:DEMASO
Suffix:
Gender:F
Credentials:PSYS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10501 ROCHESTER WAY
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-1711
Mailing Address - Country:US
Mailing Address - Phone:813-833-0090
Mailing Address - Fax:813-852-3673
Practice Address - Street 1:10501 ROCHESTER WAY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-1711
Practice Address - Country:US
Practice Address - Phone:813-833-0090
Practice Address - Fax:813-852-3673
Is Sole Proprietor?:No
Enumeration Date:2014-02-14
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist