Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 2530 | FL |
NPI | 1588664973 |
---|---|
Provider Name | Scott Anderson |
First Address | Tampa, FL 33612-3407 |
Second Address | Tampa, FL 33612-3407 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2005 |
Last Update Date | 04/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
510429195 | TAX ID (01) | FL |