Provider Demographics
NPI:1932388162
Name:MICHAEL J. POFF, LCSW, PA
Entity Type:Organization
Organization Name:MICHAEL J. POFF, LCSW, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:POFF
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, PA
Authorized Official - Phone:813-964-5684
Mailing Address - Street 1:1325 W FLETCHER AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-3310
Mailing Address - Country:US
Mailing Address - Phone:813-964-5684
Mailing Address - Fax:813-908-2880
Practice Address - Street 1:1325 W FLETCHER AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-3310
Practice Address - Country:US
Practice Address - Phone:813-964-5684
Practice Address - Fax:813-908-2880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW00030191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ5357Medicare PIN