1396933446 NPI number — EILEEN GUSTAFSON LCSW PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396933446 NPI number — EILEEN GUSTAFSON LCSW PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EILEEN GUSTAFSON LCSW PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396933446
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/12/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5797
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRING HILL
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34611-5797
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-428-8463
Provider Business Mailing Address Fax Number:
352-597-2074

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10335 CROSS CREEK BLVD
Provider Second Line Business Practice Location Address:
SUITE 23
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33647-2795
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-428-8463
Provider Business Practice Location Address Fax Number:
352-597-2074
Provider Enumeration Date:
10/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GUSTAFSON
Authorized Official First Name:
EILEEN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/THERAPIST
Authorized Official Telephone Number:
352-428-8463

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  LCSW 6283 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com