| NPI | 1306114301 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTIN M ROTH Owner 813-872-1525 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2011-12-05 |
| Last Update Date | 2011-12-05 |