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Organization
PEDIATRIC HEALTH CHOICE
Active
Organization
PEDIATRIC HEALTH CHOICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
N A (VICE PREESIDENT OF BEHAVIORAL HEALT)
(813) 769-1170
Entity
Organization
Contact information
Practice address
8509 BENJAMIN RD STE A-D, TAMPA, FL 33634-1224
(813) 769-1170
Mailing address
4602-C NORTH ARMENIA AVENUE, TAMPA, FL 33603
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-09-5768
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
679096896
—
FL
Enumeration date
12/17/2009
Last updated
03/21/2016
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