Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PY9953 | FL |
Y | 103TC0700X | Clinical Psychologist | PY9953 | FL |
NPI | 1003285289 |
---|---|
Provider Name | Rebecca Chermak |
First Address | Tampa, FL 33606-3578 |
Second Address | Tampa, FL 33606-3578 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/09/2015 |
Last Update Date | 15/10/2020 |