Provider Demographics
NPI:1255377727
Name:UPCAVAGE, ANN LOUISE (LMHC)
Entity type:Individual
Prefix:MRS
First Name:ANN
Middle Name:LOUISE
Last Name:UPCAVAGE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3104 W. WATERS AVENUE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-2876
Mailing Address - Country:US
Mailing Address - Phone:813-932-3993
Mailing Address - Fax:813-932-3902
Practice Address - Street 1:3104 W WATERS AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-2800
Practice Address - Country:US
Practice Address - Phone:813-932-3993
Practice Address - Fax:813-932-3902
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH0002960101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health