Provider Demographics
NPI:1205957727
Name:POWERS, GERALD (JAY) RALPH JR (PHD)
Entity type:Individual
Prefix:DR
First Name:GERALD (JAY)
Middle Name:RALPH
Last Name:POWERS
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211-B SOUTH GOMEZ AVE.
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-3124
Mailing Address - Country:US
Mailing Address - Phone:813-870-0919
Mailing Address - Fax:813-870-0063
Practice Address - Street 1:211B SOUTH GOMEZ AVE.
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-3124
Practice Address - Country:US
Practice Address - Phone:813-870-0919
Practice Address - Fax:813-870-0063
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0006211103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist