Provider Demographics
NPI:1831174622
Name:TRITSOS, PAUL (PSYD)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:
Last Name:TRITSOS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 19135
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32417-1035
Mailing Address - Country:US
Mailing Address - Phone:850-215-6230
Mailing Address - Fax:850-215-6235
Practice Address - Street 1:2680 CHAPMAN DR
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4914
Practice Address - Country:US
Practice Address - Phone:850-215-6230
Practice Address - Fax:850-215-6235
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-14
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6921103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL74136OtherBLUE CROSS BLUE SHIELD
FL74136OtherBLUE CROSS BLUE SHIELD
FL74136Medicare ID - Type Unspecified
FL74136ZMedicare PIN