| NPI | 1104070200 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FELIX J SUBERVI Clinical Psychologist 813-876-1832 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: FL PY5313) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH 4892) |
| Enumeration Date | 2008-11-17 |
| Last Update Date | 2008-11-17 |